Periappendicitis Is a Significant Clinical Finding Aaron S. Fink, MD, Cincinnati,Ohio,Christopher A. Kosakowski, MD, Santa Rosa,California,Jonathan R. Hiatt, MD, mlistair J. Cochran, MD, LosAngeles,California
Periappendicitis has heretofore been regarded as a pathologic curiosity with little clinical significance. In this report, we have reviewed the UCLA experience with periappendicitis. Between 1955 and 1985, resected appendices of 353 patients showed periappendicitis on pathologic examination. Sixtyone of these patients, in whom exploratory surgery was performed for reasons other than acute appendicitis, underwent incidental appendectomy. In 251 of the remaining 292 patients, appendectomy was performed either for pathologically confirmed acute appendicitis or concomitant with treatment of other unsuspected abnormalities discovered intraoperatively. Although the remaining 41 patients were also believed to have acute appendicitis, their resected specimens revealed only periappendicitis. The latter group was composed of 9 males and 32 females, with a mean age of 29 years (range: 6 to 76 years). Twenty-four complications occurred in 18 of these patients (44%). Seven additional operative procedures were required in 5 of the 41 patients (12%). One patient died (2%). We conclude that identification of periappendicitis in the patient presumed to have acute appendicitis is of definite clinical significance and may merit further clinical investigation.
lthough much has been written regarding the diagnosis and treatment of acute appendicitis and its comA plications, little attention has been devoted to periappendicitis (Figures 1 and 2). Is further work-up necessary if the pathologist reports that the histology of an appendix removed for presumed acute appendicitis demonstrates only serosal inflammation? O'Neil and Moore [1], in their review of 12 patients, declared that periappendicitis was only a pathologic curiosity of little or no clinical significance. We reviewed the UCLA experience with periappendicitis in an effort to better define the clinical importance of an entity that we perceive as unusual but potentially morbid. From the Departmentof Surgery,Universityof CincinnatiMedical Center,Cincinnati,Ohio,and the DepartmentsofSurgeryandPathology, UCLAMedicalCenter,LosAngeles,California. Requests for reprints shouldbe addressedto Aaron S. Fink,MD, Department of Surgery, Universityof Cincinnati Medical Center, ML558, 231 BethesdaAvenue,Cincinnati,Ohio45267-0558. Manuscript submitted January 24, 1989, revisedMay 18, 1989, and July 17, 1989,and acceptedAugust2, 1989. 564
MATERIAL AND METHODS Between 1955 and 1985, 3,443 appendiceal specimens were received in the UCLA Medical Center Department of Pathology (Figure 3). Among these were specimens from 353 patients in whom pathologic examination of the appendix revealed periappendicitis. Sixty-one of these patients had been taken to surgery with a preoperative diagnosis other than acute appendicitis; appendectomy was performed incidental to treatment of other intra-abdominal abnormalities. The remaining 292 patients had undergone exploratory surgery with a preoperative diagnosis of acute appendicitis. In 251 of the 292 cases, appendectomy was performed either for treatment of pathologically confirmed acute appendicitis or concomitant with treatment of other abnormalities recognized intraoperatively. In the remaining 41 cases, the postoperative impression was either acute appendicitis or unexplained abdominal pain, and treatment was based on that presumption. However, in these 41 patients, histologic examination of the resected appendix revealed only periappendicitis. The perioperative courses of these 41 patients form the basis of this review. The sex, age, nature and duration of symptoms, presenting physical, laboratory and radiographic findings, intraoperative findings, hospital course, and postoperative complications were tabulated for this group of 41 patients. Patients with significant postoperative morbidity were compared with those patients with an uncomplicated postoperative course. Statistical comparisons were performed using Student's t test and the chi-square test; p
Periappendicitis has heretofore been regarded as a pathologic curiosity with little clinical significance. In this report, we have reviewed the UCLA experience with periappendicitis. Between 1955 and 1985, resected appendices of 353 patients showed periappendicitis on pathologic examination. Sixtyone of these patients, in whom exploratory surgery was performed for reasons other than acute appendicitis, underwent incidental appendectomy. In 251 of the remaining 292 patients, appendectomy was performed either for pathologically confirmed acute appendicitis or concomitant with treatment of other unsuspected abnormalities discovered intraoperatively. Although the remaining 41 patients were also believed to have acute appendicitis, their resected specimens revealed only periappendicitis. The latter group was composed of 9 males and 32 females, with a mean age of 29 years (range: 6 to 76 years). Twenty-four complications occurred in 18 of these patients (44%). Seven additional operative procedures were required in 5 of the 41 patients (12%). One patient died (2%). We conclude that identification of periappendicitis in the patient presumed to have acute appendicitis is of definite clinical significance and may merit further clinical investigation.
lthough much has been written regarding the diagnosis and treatment of acute appendicitis and its comA plications, little attention has been devoted to periappendicitis (Figures 1 and 2). Is further work-up necessary if the pathologist reports that the histology of an appendix removed for presumed acute appendicitis demonstrates only serosal inflammation? O'Neil and Moore [1], in their review of 12 patients, declared that periappendicitis was only a pathologic curiosity of little or no clinical significance. We reviewed the UCLA experience with periappendicitis in an effort to better define the clinical importance of an entity that we perceive as unusual but potentially morbid. From the Departmentof Surgery,Universityof CincinnatiMedical Center,Cincinnati,Ohio,and the DepartmentsofSurgeryandPathology, UCLAMedicalCenter,LosAngeles,California. Requests for reprints shouldbe addressedto Aaron S. Fink,MD, Department of Surgery, Universityof Cincinnati Medical Center, ML558, 231 BethesdaAvenue,Cincinnati,Ohio45267-0558. Manuscript submitted January 24, 1989, revisedMay 18, 1989, and July 17, 1989,and acceptedAugust2, 1989. 564
MATERIAL AND METHODS Between 1955 and 1985, 3,443 appendiceal specimens were received in the UCLA Medical Center Department of Pathology (Figure 3). Among these were specimens from 353 patients in whom pathologic examination of the appendix revealed periappendicitis. Sixty-one of these patients had been taken to surgery with a preoperative diagnosis other than acute appendicitis; appendectomy was performed incidental to treatment of other intra-abdominal abnormalities. The remaining 292 patients had undergone exploratory surgery with a preoperative diagnosis of acute appendicitis. In 251 of the 292 cases, appendectomy was performed either for treatment of pathologically confirmed acute appendicitis or concomitant with treatment of other abnormalities recognized intraoperatively. In the remaining 41 cases, the postoperative impression was either acute appendicitis or unexplained abdominal pain, and treatment was based on that presumption. However, in these 41 patients, histologic examination of the resected appendix revealed only periappendicitis. The perioperative courses of these 41 patients form the basis of this review. The sex, age, nature and duration of symptoms, presenting physical, laboratory and radiographic findings, intraoperative findings, hospital course, and postoperative complications were tabulated for this group of 41 patients. Patients with significant postoperative morbidity were compared with those patients with an uncomplicated postoperative course. Statistical comparisons were performed using Student's t test and the chi-square test; p
