Abstract
Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 and 2017 with appendiceal abscess and scheduled for interval appendectomy were reviewed. The specimens were evaluated for grade of inflammation, type and distribution of cellular infiltrate, presence of necrosis or hemorrhage and infiltrate in the serosa. Forty-two patients had appendiceal abscess and were treated conservatively. Seven underwent emergent appendectomy. Thirty-three out of 35 patients underwent elective interval appendectomy. Thirty-two specimens were revised. Carcinoid tumor or other malignant lesions were not found. All of them presented some amount of inflammation, grade 1 to 2 in 53%, grade 3 to 4 in 47%. Twenty-five percent of the specimens had signs of necrosis accompanied by hemorrhage and in more than the half (53%) the infiltrate extended to the serosa. Conclusions: Although the appendix was mostly found not macroscopically inflamed intraoperatively, histology confirmed a certain grade of inflammation even months after the conservative treatment. No correlation was found between histopathologic findings and lapse of time between abscess treatment and interval appendectomy.
Highlights
The presence of an appendiceal mass at the time of the diagnosis complicates two to nine percent of the appendicitis [1,2]
We reviewed the pathologic specimens from interval appendectomy in search of signs of inflammation
Two female patients were lost at follow up and one of them was admitted 8 months later with another appendiceal abscess and underwent emergent appendectomy
Summary
The presence of an appendiceal mass at the time of the diagnosis complicates two to nine percent of the appendicitis [1,2]. It can be suspected in patients with a palpable mass or with more than three days of symptoms, and it is more common in children younger than five years. Conservative treatment of appendiceal abscess and subsequent interval appendectomy has become an increasingly common practice. The success of this protocol, in terms of decreased complications and hospital stay length compared with traditional immediate operation, has already been demonstrated [3]. The risk of recurrence, which tended to happen in the majority of cases within 6 months after the initial hospital stay, had been estimated for 10–14% [1]
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