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A Pediatric Case of Granulomatous Appendicitis Operated Due to Recurrent Abdominal Pain
Hasan Madenci1, Cuneyt Ugur2, Sabit Dere3
1Department of Pediatric Surgery, University of Health Sciences Türkiye, Konya City Health Application and Research Center, Konya, Türkiye.
Insights
Granulomatous appendicitis (GA), an inflammation of the appendix, is often idiopathic. This case highlights its consideration in pediatric patients with abdominal pain, recommending appendectomy for diagnosis.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Pathology
Background:
- Granulomatous appendicitis (GA) is a rare condition characterized by granulomatous inflammation of the appendix wall.
- While often idiopathic, GA can be associated with various systemic diseases including Crohn's disease, infections (tuberculosis, parasitic), and foreign bodies.
Observation:
- An 11-year-old male presented with a 3-month history of abdominal pain, bilious vomiting, and right lower quadrant tenderness.
- Initial ultrasound suggested plastron appendicitis, leading to an appendectomy.
- Microscopic examination revealed appendix wall thickening, edema, fibrosis, and lymphoid infiltration.
Findings:
- The patient was diagnosed with idiopathic granulomatous appendicitis as no underlying causative disease was identified.
- Histopathological analysis confirmed significant inflammatory changes within the appendix.
Implications:
- Granulomatous appendicitis should be considered in pediatric patients presenting with firm, difficult-to-mobilize appendix masses, especially to rule out malignancy.
- Appendectomy is crucial for diagnosis and management, preceding decisions on more extensive surgical procedures.
Abstract:
Granulomatous appendicitis (GA) is granulomatous inflammation of the appendix wall. It is generally idiopathic; however, it may also be associated with many diseases such as Crohn's disease, parasitic infections, tuberculosis, or foreign bodies. An 11-year-old male patient, with a 3-month history of abdominal pain and bilious vomiting, had right lower quadrant abdominal tenderness. His white blood cell count was 8.6 x103/µL. An abdomen ultrasound was considered to show plastron appendicitis and an appendectomy was performed. Microscopically, thickening of the appendix wall with edema, fibrosis and lymphoid infiltration was observed. The patient was evaluated as idiopathic GA since no disease was detected that caused GA. When the appendix has a firm consistency and is difficult to separate from the surrounding tissues, GA should be considered before malignancy, particularly in the pediatric age group. An appendectomy should be performed before deciding on radical surgery.
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