Beyond Appendicitis: A Retrospective Study Predicting Appendiceal Neoplasms in the Era of Non-Operative Management in...

The shift toward non-operative management of acute appendicitis raises concerns for delayed diagnosis of appendiceal neoplasms. Our aim was to determine the prevalence and predictors of appendiceal neoplasms among patients presenting with acute appendicitis.

This retrospective cohort study at the University Hospital of the West Indies (UHWI) identified consecutive patients who underwent appendicectomy from January 2016 to December 2020. Clinical records were reviewed to confirm a preoperative diagnosis of acute appendicitis; cases operated for other indications were excluded. Bivariate analyses and Firth's logistic regression models compared patients with and without neoplasms to identify independent demographic, clinical, laboratory, and radiological predictors.

Of 441 patients with acute appendicitis, 12 (2.72%) had appendiceal tumours. Independent predictors of neoplasm were age > 30 years (OR = 9.12; 95% CI 1.65-50.52; p = 0.011), atypical abdominal pain (OR = 4.08; 95% CI 1.32-12.65; p = 0.015), ANC < 10 × 10⁹/L (OR = 4.16; 95% CI 1.03-16.75; p = 0.045), and appendiceal diameter > 15 mm (OR = 5.49; 95% CI 1.5-20.05; p = 0.010). Low-grade appendiceal mucinous neoplasm (LAMN) was the most common subtype (6/12); neuroendocrine tumour and adenocarcinoma were each identified in one case.

Appendiceal tumours were present in 2.72% of patients treated surgically for acute appendicitis. Age > 30 years, atypical abdominal pain, low ANC, and enlarged appendiceal diameter may help risk-stratify patients considered for non-operative management.