Incidence and outcomes of unexpected pathology findings after appendectomy Hanna Alemayehu, Charles L. Snyder, Shawn D. St. Peter ⁎, Daniel J. Ostlie The Children’s Mercy Hospital, Kansas City, MO abstract article info Article history: Received 5 November 2013 Received in revised form 13 December 2013 Accepted 12 January 2014 Key words: Appendectomy Pathology Outcomes Treatment Purpose: Pathologic evaluation of the appendix after appendectomy is routine and can identify unexpected findings. We evaluated our experience in children undergoing appendectomy to review the clinical course of patients with unexpected appendiceal pathology. Methods: After IRB approval, a retrospective review was conducted on patients who underwent appendectomy from January 1, 1995 to March 1, 2011. Patient demographics, diagnosis, pathological findings, disease outcomes, and treatment were collected only on patients with abnormal pathology. Results: 3602 patients underwent appendectomy. 113 patients had normal appendices, and 86 patients had unexpected findings, including carcinoid tumor (n = 9), pinworm (n = 34), granuloma (n = 14), eosinophilic infiltrates (n = 18), and other (n = 11). All cases of carcinoid tumor were completely resected, with no recurrence or need for reoperation. Of the 34 patients with pinworm infestation, 41.2% underwent antimicrobial therapy, and none had post-operative symptoms. One patient (7%) with an appendiceal granuloma developed Crohn’s disease. Three patients (16.7%) with eosinophilia developed symptomatic intestinal eosinophilia. Conclusions: Pediatric appendiceal carcinoid is an incidental finding; in this series, none required further intervention. Appendiceal granulomas are not commonly associated with developing Crohn’s disease in the short term. Routine antibiotics for the treatment of pinworms are adequate. Patients with appendiceal eosinophilia may develop symptomatic intestinal eosinophilia. © 2014 Elsevier Inc. All rights reserved. Acute appendicitis is the most common condition necessitating abdominal surgery and is one of the most common causes of abdominal pain in children [1–8]. The etiology of acute appendicitis is hypothesized as being secondary to obstruction of the appendiceal lumen resulting in ischemic mucosal damage and secondary bacterial invasion [3,4,8,9]. The most common causes of appendiceal obstruc- tion are fecal stasis and/or fecaliths that result in bacterial overgrowth [8], however other luminal processes may result in appendicitis or even mimic appendicitis [3,4,9–11]. Therefore, the histopathological examination may be relevant. We audited our experience with appendectomies to define the incidence of unexpected pathological findings and outline the clinical course created by these findings. 1. Methods After Institutional Review Board approval (#11 09-158E), we conducted a retrospective review on all patients who underwent an appendectomy at our institution from January 1, 1995 to March 1, 2011. Patient medical records were reviewed and clinical data were collected. Data recorded included demographics, diagnosis, patholog- ical findings, disease outcomes, and treatment for all patients identified with abnormal pathology. Only patients with abnormal pathology were included in the study. 2. Results 3602 appendectomies were performed during the study period. A normal appendix was documented by the pathologist in 113 cases (3.1%). Overall, 86 patients (2.4%) had unexpected pathological findings. Unusual pathology was suspected in only 4 patients (4.7%) after gross review by the surgeon and pathologist; all other patients were suspected to have either acute appendicitis or a normal appendix. Demographics are listed in Table 1. Abnormal pathological findings were carcinoid (n = 9), pinworm (n = 34), granuloma (n = 14), eosinophilic infiltrates (n = 18), and other (n = 11). Table 2 lists the clinical signs and symptoms at presentation for all patients. Carcinoid tumor of the appendix was an incidental finding in all 9 patients. All patients in this group had a preoperative computed tomography (CT) scan and acute appendicitis was the most common finding (n = 7), with 2 patients having CT findings suggestive of appendiceal perforation. The remaining 2 patients had preoperative CT findings of intussusception and bowel obstruction. All surgical margins were negative, no recurrences occurred, and no subsequent treatments were needed in any of the patients. Additionally, there Journal of Pediatric Surgery 49 (2014) 1390–1393 ⁎ Corresponding author at: Department of Surgery, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108. Tel: +1 816 983 3575; fax: +1 816 983 6885. E-mail address: sspeter@cmh.edu (S.D. St. Peter). http://dx.doi.org/10.1016/j.jpedsurg.2014.01.005 0022-3468/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg