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ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 249-251

A retrospective study of histopathological features of appendectomy specimens at Amreli district-Gujarat


Department of Pathology, Shantabaa Medical College and General Hospital, Amreli, Gujarat, India

Date of Submission09-Feb-2021
Date of Acceptance26-May-2021
Date of Web Publication22-Mar-2022

Correspondence Address:
Dr. Abhishek R Godhani
Mehulnagar Block No. B/50, Near Telephone Exchange, Jamnagar - 361 006, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrntruhs.jdrntruhs_15_21

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  Abstract 


Background and Objective: Acute appendicitis is the most common general surgical emergency. Appendicectomy for acute appendicitis is one of the most commonly performed surgical procedures. A retrospective study was performed to evaluate histological diagnosis, geographical data, and the rate of different appendicitis.
Methods: This study was retrospective, conducted at Shantabaa Medical College & General Hospital, Amreli during the period of 7 months from July 2020 to January 2021. All emergency appendectomies and planned appendectomies performed on clinically suspected appendicitis were included. Total 101 cases were included. Patients' age, gender, sign and symptoms, and operative findings were noted.
Results: Out of these 101 specimens, 100 (99.0%) cases were appendicitis histologically, and 1 (0.99%) case was normal appendix. There were 44 (43.56%) male and 57 (56.43%) female, with the male:female ratio of 0.77:1. Maximum numbers of female and male both were from 21 to 30 age.
Conclusion: The present study showed maximum cases in the second and third decades. The study suggests routine histological examination of all the appendicectomy specimens to avoid missing any clinically important and treatable condition.

Keywords: Appendicitis, appendicectomy, histopathology


How to cite this article:
Kagathara PD, Godhani AR. A retrospective study of histopathological features of appendectomy specimens at Amreli district-Gujarat. J NTR Univ Health Sci 2021;10:249-51

How to cite this URL:
Kagathara PD, Godhani AR. A retrospective study of histopathological features of appendectomy specimens at Amreli district-Gujarat. J NTR Univ Health Sci [serial online] 2021 [cited 2022 Oct 2];10:249-51. Available from: https://www.jdrntruhs.org/text.asp?2021/10/4/249/339813




  Introduction Top


Appendicitis is inflammation of the appendix.[1] Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite.[1] However, approximately 40% of people do not have these typical symptoms.[1] Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall and sepsis.[2]

Appendicitis is caused by a blockage of the hollow portion of the appendix.[3] This is most commonly due to a calcified “stone” made of feces.[2] Inflamed lymphoid tissue from a viral infection, parasites, gallstones, or tumors may also cause the blockage.[2] This blockage leads to increased pressures in the appendix, decreased blood flow to the tissues of the appendix, and bacterial growth inside the appendix causing inflammation.[2],[4] The combination of inflammation, reduced blood flow to the appendix, and distention of the appendix causes tissue injury and tissue death.[5] If this process is left untreated, the appendix may burst, releasing bacteria into the abdominal cavity, leading to increased complications.[5],[6]

Appendicitis is most common between the ages of 5 and 40;[7] the median age is 28. Risk factors include being male, higher household income, or living in a rural area.[8] In 2013, it resulted in 72,000 deaths globally, down from 88,000 in 1990.[9]

In the United States, there were nearly 293,000 hospitalizations involving appendicitis in 2010.[10] Appendicitis is one of the most frequent diagnoses for emergency department visits resulting in hospitalization among children aged 5–17 years in the United States.[11]

This study aimed to determine the various histological diagnoses of all surgically removed appendices and to find out the age- and sex-related occurrence of appendicitis, the perforation rate, and the rate of negative appendectomies.


  Methods Top


This study was retrospective, conducted at Shantabaa Medical College & General Hospital, Amreli during the period of 7 months from July 2020 to January 2021. All emergency appendectomies and planned appendectomies performed on clinically suspected appendicitis were included. Total 101 cases were included. All the surgically resected appendices received at the Department of Pathology were included in this study. All these specimens were fixed in 10% phosphate-buffered formaldehyde solutions, embedded in paraffin, and sections were prepared for microscopy after staining with hematoxylin and eosin. Patients' age, gender, sign and symptoms, and operative findings were noted. Histopathological diagnoses were taken and assessed according to age and gender.

The hallmark of acute appendicitis is neutrophilic infiltrates of the wall of the appendix. Acute mucosal inflammation is usually present. Often neutrophilic infiltrates are present within the lumen. Histologic findings alone are not sufficient to diagnose acute appendicitis. Depending on the severity of the inflammation, variable necrosis of the appendiceal wall is present with mucosal sloughing. Suppurative appendicitis is associated with obstruction (fecalith, worms) and abscess formation within the wall, and foci of suppurative necrosis in the mucosa. In negative appendectomy, the clinical presentation is like acute appendicitis but in which the appendix is found to be normal on histopathological examination. Study conatain retrospective data from pathology histopathology department only, so ethical committee approval is not taken.


  Results Top


Total 101 specimens of the appendix were examined in the histopathology department at Shantabaa Medical College, Amreli during the period of 7 months from July 2020 to January 2021. Out of these 101 specimens, 100 (99.0%) cases were appendicitis histologically, and 1 (0.99%) casewas the normal appendix. There were 44 (43.56%) male and 57 (56.43%) female, with the male:female ratio of 0.77:1. Maximum numbers of female and male both were from 21 to 30 age. So, maximum cases were from the second and third decades. The distribution of appendicitis according to the age group is shown in [Table 1].
Table 1: The distribution of appendicitis according to age group

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Histopathological examination showed maximum cases of acute appendicitis (48.51%) followed by chronic appendicitis (42.57%). The remaining cases were gangrenous appendicitis, perforation, eosinophilic appendicitis, and periappendicitis [Table 2].
Table 2: Histopathological examination of appendix

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  Discussion Top


Appendicitis is most common between the ages of 5 and 40;[7] the median age is 28. Risk factors include being male, higher household income, or living in a rural area.[8] In 2013, it resulted in 72,000 deaths globally, down from 88,000 in 1990.[9]

In the United States, there were nearly 293,000 hospitalizations involving appendicitis in 2010.[10] Appendicitis is one of the most frequent diagnoses for emergency department visits resulting in hospitalization among children aged 5–17 years in the United States.[11]

Total 101 specimens of the appendix were examined during the period of 7 months from July 2020 to January 2021 in our study. Out of these 101 specimens, 100 (99.0%) cases were appendicitis histologically, and 1 (0.99%) cases was the normal appendix. Males were 44 (43.56%) and females were 57 (56.43%), with the male:female ratio of 0.77:1. Maximum numbers of female and male both were from 21 to 30 age.

Similar findings were observed by Shreshtha et al.,[12] Ojo et al.,[13] and Zulfikar et al.[10] 80% of cases were in the age group of <40 years similar to other studies. Our study had a male:female ratio of 0.77:1 showing high female preponderance matching with the study of Shreshtha et al. Similar study in Kolkata in 2016 also showed higher female preponderance with maximum cases from the second and third decades.[14]


  Conclusion Top


Appendicitis incidence is high in the second and third decades of life. Routine histopathological examination of the appendix must be undertaken in all cases. Unusual pathologies though rarely seen, but their final confirmation can be done only on histopathology. Until more reliable data become available, histopathological examination of the appendix should continue to be carried out.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Graffeo CS, Counselman FL. Appendicitis. Emerg Med Clin North Am 1996;14:653-71.  Back to cited text no. 1
    
2.
Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012. p. Chapter 300. ISBN 978-0-07174889-6. Archived from the original on 30 March 2016. [Last accessed on 2014 Nov 06].  Back to cited text no. 2
    
3.
Pieper R, Kager L, Tidefeldt U. Obstruction of appendix vermiformis causing acute appendicitis. An experimental study in the rabbit. Acta Chir Scand 1982;148:63-72.  Back to cited text no. 3
    
4.
Tintinalli JE editor. Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011. p. Chapter 84. ISBN 978-0-07-174467-6. Archived from the original on 22 December 2016. [Last accessed on 2014 Nov 06].  Back to cited text no. 4
    
5.
Charles BF, Dana K, Timothy RB, David L, John G, Raphael E. Schwartz's Principles of Surgery. 9th ed. New York: McGraw-Hill Medical Pub. Division; 2010. p. Chapter 30.  Back to cited text no. 5
    
6.
Barrett ML, Hines AL, Andrews RM. Trends in Rates of Perforated Appendix, 2001–2010: Statistical Brief #159. 2013. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006. http://www.ncbi.nlm.nih.gov/books/NBK169006/. [Last accessed on 2021 Feb].  Back to cited text no. 6
    
7.
Ellis H. Acute appendicitis. Br J Hosp Med 2012;73:C46-8.  Back to cited text no. 7
    
8.
“Appendicitis”. VoxHealth.co. Archived from the original on 2016-06-29. [Lase accessed on 2016 Jun 16].  Back to cited text no. 8
    
9.
GBD 2013 Mortality Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385:117-71.  Back to cited text no. 9
    
10.
Sinha RT, Dey A. A retrospective study of histopathological features of appendectomy specimens – What all can expect? J Med Sci Health 2016;2:6-12.  Back to cited text no. 10
    
11.
Wier LM, Yu H, Owens PL, Washington R. Overview of children in the emergency department, 2010: statistical brief# 157.  Back to cited text no. 11
    
12.
Shreshtha R, Ranabhat SR, Tiwari M. Histopathological analysis of appendectomy specimens. J Pathol Nepal 2012;2:215-9.  Back to cited text no. 12
    
13.
Ojo OS, Udeh SC, Odesanmi WO. Review of the histopathological findings in appendices removed for acute appendicitis in Nigerians. J R Coll Surg Edinb 1991;36:245-8.  Back to cited text no. 13
    
14.
Sinha RT, Dey A. A retrospective study of histopathological features of appendectomy specimens – What all can expect? J Med Sci Health 2016;2:6-12.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2]



 

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