Pathological analysis of Acute appendicitis

Introduction: Acute appendicitis is one of the commonest surgical problems encountered in clinical practice. Pathological evaluation is the gold standard to diagnose acute appendicitis. Objective: To describe the pathology of clinically diagnosed acute appendicitis. Methodology: Pathology reports of appendectomies done over 2 years at this institution were analyzed. Results: 125 patients were included. 46% appendices were macroscopically normal but 79% of them were microscopically pathological. 90% appendices were pathological and microscopic evidence of acute inflammation was found in 82% of them. 12.5% and 3.5% of them had lymphoid hyperplasia and chronic inflammation respectively without any pathological evidence of acute appendicitis. Luminal obstruction was seen in 30% of appendices and 49% of them were histologically normal. 49% appendices with luminal obstruction had microscopic evidence of acute inflammation. Faecolith (49%), lymphoid hyperplasia (38%), fibrosis (8%), parasites (3%) and endometrial tissue (3%) were found obstructing the lumen. 78% of appendices with faecoliths were pathological and 93% of appendices with lymphoid hyperplasia had no pathological evidence of acute appendicitis.Conclusion: Clinical assessment is fairly accurate in diagnosis of acute appendicitis. Luminal obstruction may not be a significant process in pathogenesis, though obstruction with faecolith can commonly cause acute appendicitis. Luminal obstruction (mostly by lymphoid hyperplasia) without acute inflammation may be a reason for clinical presentation of acute appendicitis.