Dilemma of mucosal appendicitis: a clinico-pathological entity? A retrospective cohort study

Mizumoto, Ryo, Cristaudo, Adam T., Lai, Nai Kid, Premaratne, Gamini and Hendahewa, Rasika (2018) Dilemma of mucosal appendicitis: a clinico-pathological entity? A retrospective cohort study. ANZ Journal of Surgery, 88 4: E284-E288. doi:10.1111/ans.13820


Author Mizumoto, Ryo
Cristaudo, Adam T.
Lai, Nai Kid
Premaratne, Gamini
Hendahewa, Rasika
Title Dilemma of mucosal appendicitis: a clinico-pathological entity? A retrospective cohort study
Journal name ANZ Journal of Surgery   Check publisher's open access policy
ISSN 1445-2197
1445-1433
Publication date 2018-04-01
Year available 2016
Sub-type Article (original research)
DOI 10.1111/ans.13820
Open Access Status Not yet assessed
Volume 88
Issue 4
Start page E284
End page E288
Total pages 5
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Abstract The presence of mucosal inflammation within appendicectomy specimens is poorly described in the literature, and there is debate regarding the clinical significance of this histological finding. The aim of this study is to correlate clinical and radiological data with histologically confirmed acute mucosal appendicitis (MA).

A retrospective cohort study was performed to identify all patients who underwent appendicectomy over 5 years at Caboolture Hospital. Data were collected in regards to clinical Alvarado score, pathological specimen findings, radiological findings and coincidental conditions, and comparison made between MA and negative appendicectomy groups.

A total of 1347 appendicectomy specimens and data were reviewed. Of these, 219 (16%) specimens were microscopically confirmed to have acute mucosal inflammation, 150 (68%) were females. Median age was 19 ± 14 years. A total of 243 (18%) were histologically negative. There was a statistically significant difference in mean Alvarado score in the MA group (5.0 ± 1.9 versus 4.3 ± 1.8, P = 0.0002). Patients with MA are more likely to report migratory pain (48.4 versus 31.4%, P = 0.0001) and rebound tenderness (24.9 versus 14.6%, P = 0.002). Computed tomography and ultrasound scans were negative in 74.1 and 72.6%, respectively, in patients with MA. More MA patients benefited from appendicectomy compared with the negative appendicectomy group (82 versus 63%, P = <0.0001).

There is a subgroup of patients with MA who are young females with have low Alvarado scores, have non-diagnostic imaging, and may represent almost one-fifth of appendicectomy specimens. This study supports the probability that MA is a pathological entity.
Formatted abstract
Background: The presence of mucosal inflammation within appendicectomy specimens is poorly described in the literature, and there is debate regarding the clinical significance of this histological finding. The aim of this study is to correlate clinical and radiological data with histologically confirmed acute mucosal appendicitis (MA).

Methods: A retrospective cohort study was performed to identify all patients who underwent appendicectomy over 5 years at Caboolture Hospital. Data were collected in regards to clinical Alvarado score, pathological specimen findings, radiological findings and coincidental conditions, and comparison made between MA and negative appendicectomy groups.

Results: A total of 1347 appendicectomy specimens and data were reviewed. Of these, 219 (16%) specimens were microscopically confirmed to have acute mucosal inflammation, 150 (68%) were females. Median age was 19 ± 14 years. A total of 243 (18%) were histologically negative. There was a statistically significant difference in mean Alvarado score in the MA group (5.0 ± 1.9 versus 4.3 ± 1.8, P = 0.0002). Patients with MA are more likely to report migratory pain (48.4 versus 31.4%, P = 0.0001) and rebound tenderness (24.9 versus 14.6%, P = 0.002). Computed tomography and ultrasound scans were negative in 74.1 and 72.6%, respectively, in patients with MA. More MA patients benefited from appendicectomy compared with the negative appendicectomy group (82 versus 63%, P = <0.0001).

Conclusion: There is a subgroup of patients with MA who are young females with have low Alvarado scores, have non‐diagnostic imaging, and may represent almost one‐fifth of appendicectomy specimens. This study supports the probability that MA is a pathological entity.
Keyword Alvarado score
Histopathology appendicitis
Imaging and radiology of appendicitis
Mucosal and submucosal appendicitis
Negative appendicectomy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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Created: Wed, 11 Apr 2018, 12:37:36 EST