Annals of Coloproctology

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Unexpected Appendiceal Pathologies and Their Changes With the Expanding Use of Preoperative Imaging Studies: Hong Yeol Yoo, Jaewoo Choi, Jongjin Kim, Young Jun Chai, Rumi Shin, Hye Seong Ahn, Chang-Sup Lim, Hae Won Lee, Ki-Tae Hwang, In Mok Jung, Jung Kee Chung, Seung Chul Heo; Ann Coloproctol. 2017;33(3):99-105. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.99

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Purpose

The preoperative diagnosis of acute appendicitis is often challenging. Sometimes, pathologic results of the appendix embarrass or confuse surgeons. Therefore, more and more imaging studies are being performed to increase the accuracy of appendicitis diagnoses preoperatively. However, data on the effect of this increase in preoperative imaging studies on diagnostic accuracy are limited. We performed this study to explore unexpected appendiceal pathologies and to delineate the role of preoperative imaging studies in the diagnosis of acute appendicitis.

Methods

The medical records of 4,673 patients who underwent an appendectomy for assumed appendicitis between 1997 and 2012 were reviewed retrospectively. Pathological results and preoperative imaging studies were surveyed, and the frequencies of pathological results and preoperative imaging studies were investigated.

Results

The overall rate of pathology compatible with acute appendicitis was 84.4%. Unexpected pathological findings, such as normal histology, specific inflammations other than acute appendicitis, neoplastic lesions, and other pathologies, comprised 9.6%, 3.3%, 1.2%, and 1.5%, respectively. The rate of unexpected pathological results was significantly reduced because of the increase in preoperative imaging studies. The decrease in normal appendices contributed the most to the reduction while other unexpected pathologies did not change significantly despite the increased use of imaging studies. This decrease in normal appendices was significant in both male and female patients under the age of 60 years, but the differences in females were more prominent.

Conclusion

Unexpected appendiceal pathologies comprised 15.6% of the cases. Preoperative imaging studies reduced them by decreasing the negative appendectomy rate of patients with normal appendices.

Citations

Citations to this article as recorded by

Changing trends in appendiceal pathology: a 16-year retrospective extension study of surgically removed appendices in a tropical teaching hospital
Nicholas Awodele Awolola, Andrea Oludolapo Akinjo, AbdulRazzaq Oluwagbemiga Lawal, Kabir Bolarinwa Badmos, Fatimah Biade Abdulkareem
BMC Gastroenterology.2025;[Epub] CrossRef
The appendix: An unexpected band obstruction
Rowan Klein Nulend, Rakesh Quinn, Kar Yin Fok, Nimalan Pathmanathan
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The Vermiform Appendix and Its Pathologies
Marian Constantin, Livia Petrescu, Cristina Mătanie, Corneliu Ovidiu Vrancianu, Adelina-Gabriela Niculescu, Octavian Andronic, Alexandra Bolocan
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Rising incidence of appendiceal neoplasms over time: Does pathological handling of appendectomy specimens play a role?
Hisham F. Bahmad, Abed Alhalim Aljamal, Juan Carlos Alvarez Moreno, Ali Salami, Philip Bao, Sarah Alghamdi, Robert J. Poppiti
Annals of Diagnostic Pathology.2021; 52: 151724. CrossRef
The Impact of Pathological Criteria on Pediatric Negative Appendectomy Rate
Caroline Maloney, Morris C. Edelman, Alexandra C. Bolognese, Aaron M. Lipskar, Barrie S. Rich
Journal of Pediatric Surgery.2019; 54(9): 1794. CrossRef
Communication and management of incidental pathology in 1,214 consecutive appendicectomies; a cohort study
Ned Kinnear, Bridget Heijkoop, Eliza Bramwell, Alannah Frazzetto, Amy Noll, Prajay Patel, Derek Hennessey, Greg Otto, Christopher Dobbins, Tarik Sammour, James Moore
International Journal of Surgery.2019; 72: 185. CrossRef
Unexpected Appendiceal Pathologies and Preoperative Imaging Studies on Patients With Acute Appendicitis
Byung Chun Kim
Annals of Coloproctology.2017; 33(3): 82. CrossRef

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation: Rumi Shin, Sang Mok Lee, Beonghoon Sohn, Dong Woon Lee, Inho Song, Young Jun Chai, Hae Won Lee, Hye Seong Ahn, In Mok Jung, Jung Kee Chung, Seung Chul Heo; Ann Coloproctol. 2016;32(6):221-227. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.221

15,963 View
107 Download
41 Web of Science
42 Citations

Abstract PDF

Purpose

An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation.

Methods

We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated.

Results

The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels.

Conclusion

Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.

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