A1 Refereed original research article in a scientific journal
Appendicolith appendicitis is clinically complicated acute appendicitis – is it histopathologically different from uncomplicated acute appendicitis
Authors: Mallinen J, Vaarala S, Makinen M, Lietzen E, Gronroos J, Ohtonen P, Rautio T, Salminen P
Publisher: SPRINGER
Publication year: 2019
Journal: International Journal of Colorectal Disease
Journal name in source: INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
Journal acronym: INT J COLORECTAL DIS
Volume: 34
Issue: 8
First page : 1393
Last page: 1400
Number of pages: 8
ISSN: 0179-1958
DOI: https://doi.org/10.1007/s00384-019-03332-z
Web address : https://link.springer.com/article/10.1007/s00384-019-03332-z
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/41256400
Purpose: Acute appendicitis may present as uncomplicated and complicated and these disease forms differ both epidemiologically and clinically. Complicated acute appendicitis has traditionally been defined as an appendicitis complicated by perforation or a periappendicular abscess, and an appendicolith represents a predisposing factor of complicated disease. There are histopathological differences between uncomplicated acute appendicitis and the previously established traditional forms of complicated acute appendicitis, but to our knowledge, the histopathological differences between uncomplicated acute appendicitis and complicated acute appendicitis presenting with an appendicolith have not yet been reported. The study purpose was to assess these differences with two prospective patient cohorts: (1) computed tomography (CT) confirmed uncomplicated acute appendicitis patients enrolled in the surgical treatment arm of the randomized APPAC trial comparing appendectomy with antibiotics for the treatment of uncomplicated acute appendicitis and (2) patients with CT-verified acute appendicitis presenting with an appendicolith excluded from the APPAC trial.
Methods: The following histopathological parameters were assessed: appendiceal diameter, depth of inflammation, micro-abscesses, density of eosinophils, and neutrophils in appendiceal wall and surface epithelium degeneration.
Results: Using multivariable logistic regression models adjusted for age, gender, and symptom duration, statistically significant differences were detected in the depth of inflammation <= 2.8 mm (adjusted OR 2.18 (95%CI: 1.29-3.71, p=0.004), micro-abscesses (adjusted OR 2.16 (95%CI: 1.22-3.83, p=0.008), the number of eosinophils and neutrophils >= 150/mm(2) (adjusted OR 0.97 (95%CI: 0.95-0.99, p=0.013), adjusted OR 3.04 (95%CI: 1.82-5.09, p<0.001, respectively).
Conclusions: These results corroborate the known clinical association of an appendicolith to complicated acute appendicitis.
Downloadable publication This is an electronic reprint of the original article. |  | |
Downloadable publication This is an electronic reprint of the original article. | |
