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Periappendicitis and diagnostic consequences
A V Bloch1, K F Kock, L Saxtoft Hansen
1Department of Surgical Gastroenterology, Aalborg Sygehus, Denmark.
Abstract:
A ten year series of 2660 appendicectomies revealed the microscopic diagnosis to be periappendicitis in 50 cases (1, 9%). In 7 cases the appendicectomy was incidental. Of the remaining 43 patients 21 had salpingitis, 15 had other intraperitoneal inflammation, and in 7 cases no obvious explanation could be found. Peroperatively, periappendicitis was suspected in 3 of the 43 cases, in 18 patients the appendix was judged to be normal and in 17 inflamed. It is important to be aware of the existence of periappendicitis as it often produces signs of intraperitoneal inflammation.
Insights
Periappendicitis, inflammation of the appendix outer layer, was diagnosed microscopically in 1.9% of appendectomies. This condition often mimics other intraperitoneal inflammation, highlighting the need for clinical awareness.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Abdominal Surgery
Background:
- Appendicectomy is a common surgical procedure for suspected appendicitis.
- Microscopic diagnosis of periappendicitis is infrequently encountered.
- Periappendicitis can present with symptoms mimicking other intra-abdominal inflammatory conditions.
Purpose of the Study:
- To determine the incidence of microscopic periappendicitis in a large series of appendicectomies.
- To analyze the clinical and operative findings in patients with periappendicitis.
- To emphasize the importance of recognizing periappendicitis due to its potential for diagnostic confusion.
Main Methods:
- Retrospective analysis of 2660 appendicectomy cases over a ten-year period.
- Review of microscopic pathological diagnoses.
- Correlation of pathological findings with intraoperative assessments and clinical data.
Main Results:
- Microscopic periappendicitis was diagnosed in 50 cases (1.9%) out of 2660 appendicectomies.
- In 43 cases where appendicectomy was not incidental, 21 were associated with salpingitis and 15 with other intraperitoneal inflammation.
- Periappendicitis was suspected preoperatively in only 3 of 43 cases, with the appendix appearing normal or inflamed intraoperatively in the remaining cases.
Conclusions:
- Periappendicitis is an uncommon but significant microscopic diagnosis following appendicectomy.
- The condition frequently presents with signs of generalized intraperitoneal inflammation, potentially leading to misdiagnosis.
- Awareness of periappendicitis is crucial for accurate diagnosis and appropriate patient management in cases of suspected appendicitis.