Non-fecalith-induced appendicitis: etiology, imaging, and pathology

Abstract

This study aims to document the imaging and pathology findings in non-fecalith-induced appendicitis. We reviewed the imaging and pathologic findings in 40 patients with histologically proven purulent appendicitis seen over a 2-year period. Findings documented were (1) total appendiceal involvement, (2) predominant appendiceal tip involvement, (3) presence of a fecalith, and (4) presence of lymphoid hyperplasia. There were a total of 40 patients, 28 males and 12 females. The age range was 2-18 years with a mean of 11.5 years. Twenty-two (55 %) patients demonstrated classic purulent appendicitis of the whole appendix, 20 (91 %) of these appendices had a fecalith. Eighteen (45 %) patients demonstrated purulent appendicitis confined to or predominately involving the tip of the appendix, and all 18 (100 %) patients demonstrated marked lymphoid hyperplasia. Only two (11 %) of these appendices had a fecalith. Overall, a fecalith was found in only 55 % of our cases, while 45 % demonstrated no fecalith, but rather marked lymphoid hyperplasia. Lymphoid hyperplasia appeared to be the underlying predisposing cause of purulent appendicitis in these cases.

Appendicitis as a possible safety signal for the COVID-19 vaccines

“…Five ICSRs mention appendicoliths, as a reported term or in the case narrative, and all reports of appendicolith with COVID-19 vaccine are in this case series. Lymphoid hyperplasia has also been identified as an important cause of appendicitis [2] , [24] as it can cause obstruction and lead to appendicitis [16] . Appendicitis has presented simultaneously in different underlying causes of lymphadenopathy and lymphoid hyperplasia, such as viral infection, leukemia and lymphoma [4] , [18] , [24] .…”

“…Lymphoid hyperplasia has also been identified as an important cause of appendicitis [2] , [24] as it can cause obstruction and lead to appendicitis [16] . Appendicitis has presented simultaneously in different underlying causes of lymphadenopathy and lymphoid hyperplasia, such as viral infection, leukemia and lymphoma [4] , [18] , [24] . Lymphadenopathy is listed as a side-effect of the vaccines.…”

Luminal obstruction in uncomplicated appendicitis: Detection with sonography and potential clinical implications

“…Our data do not prove that obstruction leads to antibiotic failure; further analyses will be needed to address this issue. Although obstruction is not a consistent requirement for the initial development of appendicitis, earlier authors have noted that antibiotics may be insufficient when luminal obstruction is present in established appendicitis; thus, the mechanisms underlying the progression of established appendicitis may differ from those contributing to the initial onset of appendicitis. We addressed only patients with histopathologically proven disease because the distinction between complicated and uncomplicated disease is possible only with surgical specimens.…”

Appendicitis with submucosal fecalith mimicking a submucosal tumor: a case report

“…Appendicitis with fecalith(s) is often encountered in clinical practice. The ratio of appendicitis cases with fecalith has been reported in different studies [1][2][3][4], some of which have reported an association between the appendix and fecalith formation, and that fecalith formation is associated with perforation in cases of acute appendicitis and the failure of conservative treatment [5][6][7]. Others have demonstrated that fecaliths do not influence gangrenous or perforated appendicitis [3].…”