Appendiceal Obliterans Fibrosis: A Five-Year Case Series Report in a Community Hospital

Acute appendicitis is the most common appendiceal disease, however, there are some chronic inflammatory disease pathologies such as appendiceal obliterans (AO) that mimic acute appendicitis. We present a five-year retrospective case series analysis in a community hospital for patients who underwent appendectomy. Fibrous obliteration of the appendix occurs when there is a replacement of the mucosa and submucosa with fibrotic tissues. In a small community hospital, there were 195 patients that underwent appendectomy within a five-year period, in which 6.66% of patients' final pathology confirmed AO. There are some similar clinical symptoms and computed tomography (CT) findings of AO that can mimic acute appendicitis, but there is no consensus for any criteria to definitively diagnose this condition radiologically. The current method to determine the etiology of this appendiceal condition is through appendectomy followed by histological evaluation by a pathologist. We aim to analyze prior patients and their risk factors to find an alternative diagnostic method. We explore several factors including age, to determine if there can be any basis to creating a diagnostic criterion for this condition. The mean age within our case series was 58 years old. While fibrous obliteration of the appendix is a chronic inflammatory process, patients may present with acute abdominal pain, making the diagnosis difficult. Therefore, clinicians should make AO a part of their differential diagnosis which may require surgical intervention.