Annals of Coloproctology

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Original Article

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
Journal of Case Reports and Images in Surgery.2024; 10(1): 1. CrossRef
The Vermiform Appendix and Its Pathologies
Marian Constantin, Livia Petrescu, Cristina Mătanie, Corneliu Ovidiu Vrancianu, Adelina-Gabriela Niculescu, Octavian Andronic, Alexandra Bolocan
Cancers.2023; 15(15): 3872. CrossRef
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

Review

Update for Indeterminate Colitis.: Um, Jun Won; J Korean Soc Coloproctol. 2010;26(3):165-170.; DOI: https://doi.org/10.3393/jksc.2010.26.3.165

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Abstract PDF: The distinctive diagnosis of Crohn's disease (CD) and ulcerative colitis (UC) is based on a combination of clinical, histologic, endoscopic, and radiologic data. Both UC and CD show characteristic, but non-specific, pathological features that may overlap and result in a diagnosis of indeterminate colitis (IC), which was proposed by pathologists for colectomy specimens in 1978, usually from patients operated on for severe colitis, especially in cases of acute fulminant disease of the colorectum. The subgroup of patients with an uncertain diagnosis has been classified as IC. Later, the same terminology was used for patients showing no clear clinical, endoscopic, histologic, or other features allowing a diagnosis of either UC or CD. More recently, the term IC has been applied to biopsy material when it is not been possible to differentiate between UC and CD. However, this term IC has suffered varying definitions, which in addition to numerous difficulties in diagnosing inflammatory bowel disease, has led to much confusion. In resected specimens, the term colitis of uncertain type or etiology is preferred. Over time, the majority of patients remain with a diagnosis of IC or show symptoms similar to UC. Ileal pouch anal anastomosis can be performed in such patients, with outcomes of pouch failure and with functional outcomes that are similar to those in patients with UC, but with increased risk of postoperative pouch complications. This review addresses the definition of indeterminate colitis, its pathology, its natural history, and the outcomes of restorative proctocolectomy.

Original Articles

Hemorrhoidectomy Specimens: Necessity for Routine Pathologic Evaluation.: Lee, Min Ro , Hong, Chang Won , Yoon, Sang Nam , Park, Kyu Joo; J Korean Soc Coloproctol. 2005;21(3):152-156.

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Abstract PDF: PURPOSE
The aim of this study was to determine the necessity for routine pathologic evaluation of hemorrhoidectomy specimens.
METHODS
Between March 1998 and February 2001, 280 patients (185 males, 95 females) underwent a hemorrhoidectomy at Seoul National University Hospital. All patients had grade III~IV hemorrhoids, and the mean age of the patients was 51 years (range: 21~74 years). All hemorrhoidectomy specimens were examined with a hematoxylin and eosin stain of one representative section by a pathologist. We performed a retrospective analysis regarding the pathologic results for the hemorrhoidectomy specimens.
RESULTS
Two hundred sixty-seven specimens (267, 95.4%) had typical hemorrhoids reported as external and internal hemorrhoids, external hemorrhoids, hemorrhoidal varices, and thrombi. Ten patients (10, 3.2%) had additional benign pathologes such as fibroepithelial polyps (6 cases), a flat condyloma (1 case), hypertrophied papillae with a condyloma, like papillomatosis and keratosis (1 case), dyskeratotic squamous cells with koilocytotic atypia (1 case), and an inflammatory polyp (1 case). Interestingly, three patients (3, 1.1%) had carcinomas in the hemorrhoidectomy specimens. Two patients had squamous- cell carcinomas; one suffered from delayed wound healing after a previous hemorrhoidectomy, and the other had indurated lesions on the hemorrhoids. One patients who had under gone a low anterior resection due to stage-C rectal cancer 7 months before had a adenocarcinoma.
CONCLUSIONS
Because of the possibility of unsuspected anal cancer, we recommend pathologic examination of hemorr hoidectomy specimens, especially in cases of suspected indurated lesions within the hemorrhoids, delayed wound healing after a previous hemorrhoidectomy, or previous history of colon cancer.

Review of the Pathology and Differential Diagnosis of Acute Appendicitis.: Kim, Jong Po , Son, Chang Mok; J Korean Soc Coloproctol. 2003;19(4):211-215.

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44 Download

Abstract PDF: PURPOSE
Multiple methods are used to diagnose acute appendicitis. However, with the current practice, the negative laparotomy rate for acute appendicitis is from 15% up to 30%. This study was designed to evaluate various pathologies of the appendix and other intraabdominal organs of patients preoperatively diagnosed with acute appendicitis and to analyze clinically the difference between acute appendicitis and other intraabdominal inflammatory diseases.
METHODS
We reviewed the pathologic reports of 833 patients who underwent laparotomies for acute appendicitis from January 1997 to December 2001. We grouped these patients by pathology. Group I included patients with a negative appendectomy and no other intraabdominal pathology, group II included those with lesions within the appendix, and group III, those with intraabdominal lesions other than in the appendix. We also analyzed the age, sex distributions, the typical symptoms of appendicitis, the duration of symptoms, fever, and leukocytosis of 100 patients with typical appendicitis by random sampling to find the clinical differences that existed between pelvic inflammatory disease and cecal diverticular disease presented as appendicitis.
RESULTS
The diagnostic accuracy for acute appendicitis was 79.7%, and the negative appendectomy and negative laparotomy rates were 17.4% and 15.5%, respectively. The percents of patients in group I, II, and III were 10.4%, 82.6%, and 7.0%, respectively.
CONCLUSIONS
It is important to consider the possibility of various pathologies during diagnostic and operative procedures for an acute abdomen, especially one occurring in the right lower quadrant.

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