An Analysis of the Pathological Features of the Vermiform Appendix Removed for Acute Appendicitis in a Tertiary Health Centre in Nigeria

Abstract

Aim: To analyze the gross and microscopic features of acute appendicitis as seen in the histopathology department of a Nigerian tertiary health institution. Methods: The appendices of patients histologically diagnosed as acute appendicitis were used for this study. The diameter of the appendix, gross serosal features and the luminal contents were assessed. The presence or absence of mucosal microabscesses and periappendicitis were also assessed. These were all analyzed for differences in proportion using Chi square by SPSS version 16 (p is significant at <0.05). Results: Acute appendicitis accounted for 76.2% of all appendicectomy specimens received. The mean age was 25.3 years while the age range was between 4 and 67 years and the male to female ratio was 1.3:1. The highest frequency of cases was in the 21-30 year age group. The diameter of the appendix was greater than 0.8cm in about 88.2% of cases. The association between the diameter of the appendix and the diagnosis of acute appendicitis was, however, not statistically significant. The most frequent luminal finding were faecaliths (55.6%) although a large proportion of lumina were empty (33.6%). No helminths were seen. The serosa of the appendix was shiny, dull and fibrinous/purulent in 14.7%, 39.0% and 46.3% of cases respectively. A statistically significant association was noted between these serosal appearances and the occurrence of periappendicitis. Peri-appendicitis was noted in 76.1% of cases where mucosal microabscesses were observed. This association was also statistically significant. Conclusion: Although acute appendicitis is still the most common disorder of the appendix, there has been a shift in the peak age of occurrence at our centre from adolescence to early adulthood. A statistically significant association exists between the occurrence of peritonitis and the gross appearance of the serosa as well as with the presence of mucosal microabscesses but not with the diameter of the appendix.