Surgical Pathology of the Appendix in a Tropical teaching Hospital

Abstract

Acute appendicitis is the most common cause of acute surgical abdomen requiring emergency surgery both in developed and developing countries. Appendicectomies in patients presenting with clinically suspected acute appendicitis show a diversity of pathologies. The aim of this study is to evaluate the frequency and types of pathologies seen in appendicectomy samples in Lagos. This is a retrospective histopathological review of slides and paraffin embedded blocks of all appendicectomies received from within and outside the Lagos University Teaching Hospital. The clinical data such as the age, sex and clinical summary were extracted from the request forms. A total of 299 cases of appendicectomies were received during the 8-year period representing 1.7% of all biopsies. There were 164 males and 135 females with M: F ratio of 1.2:1. The ages ranged between 2months and 70years with a mean of 24.2 (SD-12.9). One hundred and eighty-seven out of 266 cases removed for suspected acute appendicitis (70.3%) showed histological evidence of acute appendicitis, 57(30.5%) of which had perforated. Fourty-eight cases (19%) showed reactive lymphoid hyperplasia, 11(4%) had evidence of extra-appendiceal peritonitis. Negative appendicectomy was recorded in 27/ 266(10.2%) Unexpected pathologies such as granulomatous inflammation and neoplastic lesions were recorded in 6 cases (2%). In conclusion, diagnostic accuracy of appendicitis, perforation rate and negative appendicectomy rate in Lagos are comparable with what has been reported in other parts of the world. Other unexpected pathologies were present in 2% underscoring the need for routine histopathological examination of all appendiceal samples.