APPENDICULAR DISEASES;

SPECTRUM IN SURGICAL PATHOLOGY

Abstract

Acute appendicitis is a common cause of acute surgical abdomen and many
appendectomies are performed daily. All disease processes involving appendix will present as
acute appendicitis. Clinically diagnosed acute appendicitis is treated by urgent appendectomy.
As most of the removed appendices will reveal acute suppurative inflammation, therefore,
appendectomy specimens are not usually submitted for histopathological examination unless
the surgeon notices advanced disease or grossly recognizable abnormalities. Objectives: The
purpose of this study is; 1, to explore the spectrum of diseases affecting the appendix in the
community; 2, to find the age and gender association of appendicular diseases; and 3, to see
if all the surgically removed appendices should be submitted for histopathological examination
as a routine procedure. Study Design: Retrospective study. Setting: Charsada Teaching
Hospital affiliated with Jinnah Medical College Peshawar. Period: January 2013 to January
2016. Methods: The histology slides and diagnoses of all the retrieved cases were reviewed
with regards to morphology, patient’s age, gender and presence or absence of any associated
disease. Results: Nine disease entities were identified affecting the appendix, which from most
to least common were acute suppurative appendicitis, lymphoid hyperplasia, fecalith, fibrous
luminal obliteration, oxyuriasis, carcinoid tumor, submucosal fibrosis, acquired diverticulosis,
and inflammatory mucocele. The first three commonest diseases were most frequent in the
second decade of life; fibrous luminal obliteration in the fourth decade, carcinoid tumors in
the third decade, and oxyuriasis in the first decade. Moreover, acute suppurative appendicitis,
fecalith, oxyuriasis, and submucosal fibrosis were more frequent in males; whereas, lymphoid
hyperplasia and fibrous luminal obliteration were more common in females. Conclusions:
Acute suppurative appendicitis was the most common histological diagnosis. Acute suppurative
appendicitis, fecalith, oxyuriasis, and submucosal fibrosis were more common in males;
whereas, lymphoid hyperplasia and fibrous luminal atresia were more common in females.
Acute suppurative appendicitis, lymphoid hyperplasia, and fecalith were most common in the
second decade of life. In view of the nine different histological disease entities identified in this
study under one clinical diagnosis of acute appendicitis, it is highly recommended to submit all
appendectomy specimens for histopathological examination.