Clinical outcomes and pathologic results following identification of appendicitis

Aims: Acute appendicitis (AA) is one of the most frequent clinical pathologies for urgent surgery in children We aimed to investigate the occurrence and distribution of pathological findings in appendectomy specimens from patients initially diagnosed with AA. Methods: The demographic information and histopathological findings of patients who underwent appendectomy at our center between 2011 and 2021 were retrospectively analyzed. Results: A total of 259 patients were included in the study. The patients were aged 38-212 months (mean 143±39), with 180 (69.5%) male patients. Based on the histopathological results, 63 (24.3%) patienst had lymphoid hyperplasia (LH), 109 (42.1%) AA, 11 (4.2%) suppurative appendicitis (SA), 46 (17.8%) phlegmonous appendicitis (PA), and 30 (11.6%) gangrenous/necrotizing appendicitis (GA). Twenty (31.7%) patients with LH and 16 patients (53.3%) with GA had an invisible appendix on ultrasound. The leucocyte count and appendix diameter were significantly lower in LH than in the other groups (for all comparisons, p<0.001). CRP level was significantly higher in the complicated groups (GA, PA,SA) than the LH and AA groups. The appendix diameter was significantly higher in the GA group than in the PA group (p=0.049). We found a positive correlation between AD and preopertaive leucocyte count, and the duration of hospitalization in days (r=0.265, p=<0.001;r=0243, p=0.001). On the other hand, there was no correlation between appendix diameter and CRP. The binary logistic regression analyses showed that high appendix diameter was a risk factor fo CA (OR:0.206, CI: 95%, 1.061-1.422, p= 0.006). Conclusion: The high rate of complicated cases (33.5%) we found in our study shows that appendicitis can still be complicated. Additionally, the conclusion has been drawn that even in serious cases such as GA, US may overlook appendicitis at a high rate. Finally new diagnostic methods should be developed for cases that do not require surgical intervention, such as LH and eosinophilic gastrointestinal pathologies (colitis).