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The Histopathology of the Appendix in Children at Interval Appendectomy
Federica Pederiva1, Rossana Bussani2, Vennus Shafiei2
1Pediatric Surgery, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy.
Insights
Conservative treatment for pediatric appendiceal abscesses is common, but interval appendectomy remains debated. Histopathology reveals persistent inflammation in removed appendices, even months after initial treatment, suggesting ongoing inflammatory processes.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Pathology
- Surgical Oncology
Background:
- Conservative management of pediatric appendiceal abscesses is widely accepted.
- The necessity of interval appendectomy following conservative treatment is a subject of ongoing clinical debate.
Purpose of the Study:
- To investigate the histopathological findings of appendices removed during interval appendectomy after conservative treatment for appendiceal abscess in children.
- To assess the presence and grade of inflammation, necrosis, hemorrhage, and serosal involvement in these specimens.
Main Methods:
- A retrospective review of pediatric patients treated for appendiceal abscess between 2010 and 2017.
- Histopathological analysis of 32 interval appendectomy specimens, evaluating inflammation, necrosis, hemorrhage, and serosal infiltrate.
- Correlation of findings with the time interval between abscess treatment and appendectomy.
Main Results:
- No carcinoid tumors or other malignancies were detected in the analyzed specimens.
- All specimens exhibited some degree of inflammation (Grade 1-2 in 53%, Grade 3-4 in 47%).
- Twenty-five percent showed necrosis with hemorrhage, and 53% had serosal infiltrate.
Conclusions:
- Histopathological examination confirms persistent inflammation in the appendix, even months after conservative treatment for appendiceal abscess.
- Intraoperative macroscopic assessment may not fully reflect the underlying microscopic inflammatory state.
- No correlation was identified between histopathological findings and the time elapsed since abscess treatment.
Abstract:
Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 and 2017 with appendiceal abscess and scheduled for interval appendectomy were reviewed. The specimens were evaluated for grade of inflammation, type and distribution of cellular infiltrate, presence of necrosis or hemorrhage and infiltrate in the serosa. Forty-two patients had appendiceal abscess and were treated conservatively. Seven underwent emergent appendectomy. Thirty-three out of 35 patients underwent elective interval appendectomy. Thirty-two specimens were revised. Carcinoid tumor or other malignant lesions were not found. All of them presented some amount of inflammation, grade 1 to 2 in 53%, grade 3 to 4 in 47%. Twenty-five percent of the specimens had signs of necrosis accompanied by hemorrhage and in more than the half (53%) the infiltrate extended to the serosa. Conclusions: Although the appendix was mostly found not macroscopically inflamed intraoperatively, histology confirmed a certain grade of inflammation even months after the conservative treatment. No correlation was found between histopathologic findings and lapse of time between abscess treatment and interval appendectomy.
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