Z. Farzal1, Z. Farzal1, N. Khan2, S. Cope-Yokoyama3, A. C. Fischer4 1UT Southwestern Medical Center,Dallas, TX, USA 2Honor Health,Phoenix, AZ, USA 3Cooks Children’s,Pathology,Fort Worth, TX, USA 4Beaumont Health System,Pediatric Surgery,Royal Oak, MI, USA
~~Introduction: Given the newly evolving paradigm of non-operative management of appendicitis, our goal was to identify the incidence of atypical diagnoses including tumors, detected among appendectomy specimens to better elucidate those potentially missed in non-operative management. The possibility of missing an alternative or co-incidental diagnosis such as carcinoid tumor in the non-operative management of appendicitis merits knowing the actual risks of nonoperative management.
Methods: An IRB-approved (062012-049) retrospective review of pediatric patients (n=6816) who underwent appendectomies at an independent children’s hospital over an 11 year period from January 2000 to December 2010 was performed. Demographics analyzed and the various multiple classifications of appendicitis was captured. Inclusion criteria required age <17 and surgery for presumed appendicitis thus excluding incidental appendectomies (n=269) from this sample with a final review of 6547 specimens.
Results: 5998 (91.6%) subjects showed true appendicitis including acute non-perforated, perforated, chronic, suppurative, gangrenous, and catarrhal appendicitis. In 224 subjects (3.4%), diagnoses other than appendicitis were identified: non-inflammatory obstruction (n=71), other infectious etiologies (n=58), non-specific inflammatory changes (n=58), extra-appendiceal pathology (n=31), tumors (n=4), and foreign body (n=2). Additionally, 6 patients with true appendicitis had co-existing carcinoid tumors. 325 specimens (5.0%) were documented as negative appendicitis.
Conclusion: This is the largest analysis of the incidence of pathologies that masquerade as appendicitis in the pediatric population conveying a broad overlap of diagnoses that present similarly or coincidently. Given the common diagnosis of appendicitis, follow-up for routine appendectomies has been streamlined and expedited in such a way that review of pathology may be overlooked; the number of infectious etiologies and tumors detected reinforces the increasing importance of pathology review in post-operative follow-up to appropriately diagnose uncommon conditions that may necessitate further work-up and treatment. Incidence of carcinoids and infections was low but will need to be considered in nonoperative management with persistence of symptoms or in follow up.