EP.TU.435A Rare Case of Granulomatous Appendicitis

Granulomatous appendicitis is a rare form of appendicitis due to a variety of causes such a foreign body, fungi, parasites, mycobacteria, Yesinia, Crohn's pathology and delayed appendicectomy. Definitive diagnosis necessitates histopathological analysis. We present an unusual case of granulomatous appendicitis in a young gentleman, incidentally detected at histopathology, along with a brief literature review. Patient presented with a classical clinical history and examination findings suggestive of acute appendicitis and underwent an emergency laparoscopic appendicectomy, followed by an uneventful post-operative recovery. Histopathological examination showed features of acute on chronic transmural inflammation with epithelioid granuloma, confirming diagnosis of granulomatous appendicitis. We hereby, aim to emphasize the significance of increased awareness required among general surgeons and pathologists, as patients with granulomatous appendicitis needs to be investigated further due to the likelihood of them having an underlying Crohn’s disease or developing it in future.

DIAGNOSING GRANULOMATOUS DISEASE DURING APPENDECTOMY

Difficulties during surgery are uncommon situations in appendectomy. For granulomatous appendicitis, literature is insufficient about surgical findings. The procedure of a 17-year-old male patient was a struggle due to adhesions. I thought a surgeon could expect granulomatous diseases by evaluating the macroscopic appearance of the appendix during surgical procedure.

Postoperative complicated appendectomy revealing Crohn’s disease in a pediatric patient

Granulomatous appendicitis is a very rare entity in children. It is related to Crohn’s disease in only 5-10% of the cases. The diagnosis of Crohn’s disease is a real challenge in the pediatric population, especially when its initial manifestation is acute appendicitis. Herein, we present a 13-year-old boy admitted for acute appendicitis. The histopathological examination was conclusive for acute granulomatous appendicitis. The development of an entero-cutaneous fistula has complicated the postoperative evolution. The failure of the conservative management required ileocecal resection. The pathological examination revealed Crohn’s disease. The one-year follow-up on the patient din not reveal any complications. We strongly support the importance of the histopathological examination of the entirely removed appendix. Careful assessment of granulomatous appendicitis is needed in order to establish its possible etiology and to initiate the adequate treatment.

HISTOPATHOLOGICAL SPECTRUM OF APPENDICITIS IN A TERTIARY HEALTH CARE CENTER

INTRODUCTION: Appendix in a nger like projection situated just near the caecum. It is located in the right iliac fossa of the abdomen. The most common pathology which arises is appendicitis and is mostly treated surgically. Although appendix is considered to be a vestigial organ, it accounts for immune function upto some extent. OBJECTIVES: To study and analyse the various histopathological forms of appendicitis MATERIALS AND METHODOLOGY: A descriptive study was undertaken to analyse the different histopathological forms of appendicitis over a period of one year in the Department of Pathology, Government Medical College, Omandurar Government Estate. The acquired data was fed into Microsoft Excel and analysis was done. RESULT: A total of 100 specimens were analysed during the study period. Maximum number of cases (62% of cases) were reported amongst females. The most common age group which was affected was 9 years to 19 years. The most common histopathological form of appendicitis was analysed to be acute appendicitis (76% of cases) The statistical data for various histo pathological types of appendicitis are as follows Subacute appendicitis – 10 cases ; Acute appendicitis – 76 cases ; Chronic appendicitis – 13 cases ; Granulomatous appendicitis – 1 case. CONCLUSION: The incidence of appendicitis is higher in the second decade of life and is remarkably high amongst females. Among the pathological types, incidence of acute appendicitis is the highest and that is seen in the second decade of life

Granulomatous Appendicitis in the Pediatric Population

Background The clinical significance of a diagnosis of granulomatous appendicitis (GA) is not well established in the pediatric population. Methods Retrospective review of the etiology and histopathology of pediatric GA at 2 large pediatric institutions. Results Forty-three (0.4%) patients had GA at a median age of 12.1 years. Twenty-two (51%) had perforated appendicitis that was medically managed prior to interval appendectomy. Sixteen of 21 noninterval appendectomies were performed for clinically suspected acute appendicitis. Among them, 1 had Crohn’s disease identified during surgery. None of the other patients had a subsequent diagnosis of inflammatory bowel disease (median follow-up of 4 weeks). There were significantly more cases with mucosal-only granulomas as well as fewer serosal granulomas in the noninterval appendectomy specimens than the interval specimens ( P = .014). When performed, special stains for microorganisms did not contribute to clinical care. In the same time period, GA was seen in 6 (6%) of 94 bowel resections for Crohn’s disease. Conclusion GA is rare in pediatric patients, with interval appendectomy being the most common etiology and only rarely associated with Crohn’s disease. Granulomas in interval appendectomies tend to be serosal-based. Special stains for infectious organisms in GA are of low diagnostic yield and have little impact on clinical management.

Appendix bleeding with painless bloody diarrhea: A case report and literature review

Appendix bleeding is an uncommon clinical phenomenon. In this article, we reported a case of appendix bleeding with painless bloody diarrhea. With the analysis of clinical features, clinical examination, experimental test and literature review, we diagnosed that the appendix bleeding might be caused by granulomatous appendicitis. This successfully cured case might be a reference for later diagnosis and treatment of appendix bleeding with painless bloody diarrhea.