1
|
Llera B, Hanna I, Jureller M. Eosinophilic appendicitis: an insidious and fortuitous diagnosis. J Surg Case Rep 2024; 2024:rjae380. [PMID: 38832065 PMCID: PMC11146031 DOI: 10.1093/jscr/rjae380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
Eosinophilic appendicitis is a rare inflammatory condition characterized by the infiltration of eosinophils into the appendix, which is often misdiagnosed as acute appendicitis given similarities in their clinical presentation. Acute eosinophilic appendicitis: a rare cause of lower gastrointestinal hemorrhage. Within this particular report, we present a case of eosinophilic appendicitis in a 42-year-old female who underwent a laparoscopic appendectomy. The purpose of this report is to increase awareness about this unique condition and emphasize the importance of considering eosinophilic appendicitis as a differential diagnosis in patients with appendicitis-like symptoms whose clinical examination and laboratory findings may suggest otherwise.
Collapse
Affiliation(s)
- Brent Llera
- Department of Surgery, New York University Grossman School of Medicine, Mineola, NY, United States
| | - Iman Hanna
- Department of Surgery, New York University Grossman School of Medicine, Mineola, NY, United States
| | - Michael Jureller
- Department of Surgery, New York University Grossman School of Medicine, Mineola, NY, United States
| |
Collapse
|
2
|
Aggelidou M, Kambouri K, Kouroupi M, Cassimos D, Foutzitzi S, Deftereos S. Acute eosinophilic appendicitis after generalized skin reaction due to unknown cause in a child: Case report and literature review. Clin Pract 2019; 9:1177. [PMID: 31579497 PMCID: PMC6763710 DOI: 10.4081/cp.2019.1177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/30/2019] [Indexed: 12/25/2022] Open
Abstract
Acute eosinophilic appendicitis (AEA) is a rare variant of appendix inflammation possibly linked to allergy. Histopathological evidence of eosinophilic infiltration of the muscularis propria and edema separating the muscle fibers is the gold standard for the diagnosis. Here, we report a case of a young boy with AEA following a skin reaction of possible allergic origin. A 6-year-old male was presented to the emergency department with a two-day diffuse abdominal pain and tenderness in the right lower quadrant. A possible allergic reaction had occurred five days before as a pruritic rash. There was no history of allergy and the stool examination was negative for parasites. The initial diagnosis was acute appendicitis, and appendectomy was performed. The histopathological diagnosis was AEA. Further studies on the proper diagnostic and treatment approach of AEA before surgery are required.
Collapse
Affiliation(s)
- Maria Aggelidou
- Department of Pediatric Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis
| | - Katerina Kambouri
- Department of Pediatric Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis
| | - Maria Kouroupi
- Department of Pathology, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis
| | - Dimitrios Cassimos
- Department of Pediatrics, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis
| | - Soultana Foutzitzi
- Department of Radiology, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | - Savas Deftereos
- Department of Radiology, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| |
Collapse
|
3
|
Mällinen J, Vaarala S, Mäkinen M, Lietzén E, Grönroos J, Ohtonen P, Rautio T, Salminen P. Appendicolith appendicitis is clinically complicated acute appendicitis-is it histopathologically different from uncomplicated acute appendicitis. Int J Colorectal Dis 2019; 34:1393-1400. [PMID: 31236679 DOI: 10.1007/s00384-019-03332-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Acute appendicitis may present as uncomplicated and complicated and these disease forms differ both epidemiologically and clinically. Complicated acute appendicitis has traditionally been defined as an appendicitis complicated by perforation or a periappendicular abscess, and an appendicolith represents a predisposing factor of complicated disease. There are histopathological differences between uncomplicated acute appendicitis and the previously established traditional forms of complicated acute appendicitis, but to our knowledge, the histopathological differences between uncomplicated acute appendicitis and complicated acute appendicitis presenting with an appendicolith have not yet been reported. The study purpose was to assess these differences with two prospective patient cohorts: (1) computed tomography (CT) confirmed uncomplicated acute appendicitis patients enrolled in the surgical treatment arm of the randomized APPAC trial comparing appendectomy with antibiotics for the treatment of uncomplicated acute appendicitis and (2) patients with CT-verified acute appendicitis presenting with an appendicolith excluded from the APPAC trial. METHODS The following histopathological parameters were assessed: appendiceal diameter, depth of inflammation, micro-abscesses, density of eosinophils, and neutrophils in appendiceal wall and surface epithelium degeneration. RESULTS Using multivariable logistic regression models adjusted for age, gender, and symptom duration, statistically significant differences were detected in the depth of inflammation ≤ 2.8 mm (adjusted OR 2.18 (95%CI: 1.29-3.71, p = 0.004), micro-abscesses (adjusted OR 2.16 (95%CI: 1.22-3.83, p = 0.008), the number of eosinophils and neutrophils ≥ 150/mm2 (adjusted OR 0.97 (95%CI: 0.95-0.99, p = 0.013), adjusted OR 3.04 (95%CI: 1.82-5.09, p < 0.001, respectively). CONCLUSIONS These results corroborate the known clinical association of an appendicolith to complicated acute appendicitis.
Collapse
Affiliation(s)
- Jari Mällinen
- Department of Surgery, Oulu University Hospital, Oulu, Finland. .,Division of Operative Care, Oulu University Hospital and Medical Research Center Oulu, University of Oulu, Oulu, Finland.
| | - Siina Vaarala
- Cancer and Translational Medicine Research Unit, University of Oulu nad Department of Pathology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu, Finland
| | - Markus Mäkinen
- Cancer and Translational Medicine Research Unit, University of Oulu nad Department of Pathology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu, Finland
| | - Elina Lietzén
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland
| | - Juha Grönroos
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland
| | - Pasi Ohtonen
- Division of Operative Care, Oulu University Hospital and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Tero Rautio
- Department of Surgery, Oulu University Hospital, Oulu, Finland.,Division of Operative Care, Oulu University Hospital and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Paulina Salminen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland.,Satakunta Central Hospital, Pori, Finland
| |
Collapse
|