Xanthogranulomatous Appendicitis: A Rare Pathological Finding Associated With Delayed Appendectomy

Xanthogranulomatous inflammation of the appendix is a rare pathological finding associated with appendicitis and chronic inflammation. Its clinical significance is not fully understood, and diagnosis is primarily based on the histopathological review as imaging findings with CT and ultrasound are non-specific. Here, we present a case of a 64-year-old female with recurrent appendicitis who underwent an appendectomy with final pathological findings consistent with xanthogranulomatous appendicitis (XGA). We discuss the higher reported incidence of XGA in interval appendectomy specimens compared to emergency appendectomies, and how this relates to its proposed pathophysiology. We found that XGA is associated with a more challenging operative field and the need to convert from a laparoscopic to an open procedure, increasing the potential risks of surgical complications. The potential development of XGA should be considered when planning an interval appendectomy as it may impact operative planning, although there is no clear consensus on its clinical significance.