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Mucosal appendicitis: How can it be differentiated from nonappendicitis?

Carlos Delgado-Miguel1,2,3, Miriam Miguel-Ferrero2, Bonifacio Delgado4

  • 1Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, SC, US.

American Journal of Clinical Pathology
|July 21, 2023
PubMed
Abstract

Insights

Mucosal appendicitis, an early stage of acute appendicitis, shows distinct inflammatory markers. Higher leukocyte and neutrophil counts, including neutrophil-to-lymphocyte ratios, differentiate it from negative appendectomies, aiding diagnosis.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Pathology
  • Diagnostic Imaging

Background:

  • Mucosal appendicitis (MA) is a controversial entity characterized by limited neutrophilic infiltration of the appendiceal mucosa.
  • Distinguishing MA from negative appendicitis (NA) is crucial for accurate diagnosis and treatment.

Purpose of the Study:

  • To investigate whether mucosal appendicitis represents an early stage of acute appendicitis (AA).
  • To determine if MA can be differentiated from negative appendectomies based on clinical and laboratory findings.

Main Methods:

  • Retrospective analysis of 1269 children undergoing appendectomy for suspected appendicitis (2017-2020).
  • Histological classification into MA (30 cases) and NA (25 cases) groups.
  • Comparison of demographic, clinical, ultrasound, and laboratory parameters between groups.

Main Results:

  • No significant differences in demographic, clinical, or ultrasound features between MA and NA groups.
  • MA group showed significantly higher leukocyte and neutrophil counts and neutrophil-to-lymphocyte ratios (NLRs) (P < .001).
  • NLR demonstrated the highest area under the curve (0.736) for MA diagnosis, with a cutoff of 3.20 offering 62.5% sensitivity and 78.9% specificity.

Conclusions:

  • Mucosal appendicitis exhibits distinct laboratory and histologic inflammatory features, supporting its classification as a pathologic entity within the acute appendicitis spectrum.
  • Preoperative leukocyte and neutrophil counts, along with NLRs, can aid in reducing negative appendectomies.
Keywords:
acute appendicitisappendectomychildrenmucosal appendicitisneutrophil to lymphocyte ratio

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