Guo Guangming, Greenson Joel K
Department of Pathology University of Michigan Helath System, Ann Arbor, MI 48109-0054, USA.
Am J Surg Pathol. 2003 Aug;27(8):1147-51. doi: 10.1097/00000478-200308000-00013.
Patients who present with a ruptured acute appendicitis are often treated with antibiotic therapy and drainage followed by a delayed or interval appendectomy. We noticed interval appendectomy specimens with granulomatous inflammation and postulated that interval appendectomy may lead to granulomatous appendicitis. To test this hypothesis, we reviewed the histopathology of all interval appendectomy specimens within a 4-year period and compared them with a control group of patients who had acute appendicitis and underwent routine acute appendectomy. All slides were randomized and reviewed blindly to assess the inflammatory patterns, with special attention given to the presence of granulomas and other Crohn-like features. Twenty-two cases of interval appendectomy were found. The interval between symptom onset and appendectomy ranged from 30 to 95 days with a mean of 58 days, whereas all 44 control patients had surgery within 72 hours of symptoms onset. Thirteen (59.1%) of the 22 interval appendectomy cases contained granulomas compared with only 3 of 44 controls (P < 0.0001). Eight (36.4%) of the interval appendectomy cases had xanthogranulomatous inflammation compared with none in the acute appendicitis group (P < 0.0001). A Crohn-like appearance was seen in 11 (50.0%) of the interval appendectomy cases and 1 of the controls (P < 0.0001). Follow-up data were available in 8 of 11 cases with Crohn-like features; none developed Crohn disease during an average follow-up period of 23 months. Delayed or interval appendectomy specimens often have a characteristic inflammatory pattern that includes granulomas, xanthogranulomatous inflammation, mural fibrosis/thickening, and transmural chronic inflammation. Without the appropriate clinical history, these changes may be misinterpreted as Crohn disease.
出现急性阑尾炎穿孔的患者通常先接受抗生素治疗和引流，随后进行延期或间隔期阑尾切除术。我们注意到间隔期阑尾切除标本存在肉芽肿性炎症，并推测间隔期阑尾切除术可能导致肉芽肿性阑尾炎。为验证这一假设，我们回顾了4年期间所有间隔期阑尾切除标本的组织病理学，并将其与一组患有急性阑尾炎并接受常规急性阑尾切除术的患者作为对照组进行比较。所有切片随机排列并进行盲法检查以评估炎症模式，特别关注肉芽肿和其他克罗恩样特征的存在情况。共发现22例间隔期阑尾切除术病例。症状出现至阑尾切除的间隔时间为30至95天，平均为58天，而所有44例对照患者在症状出现后72小时内接受了手术。22例间隔期阑尾切除病例中有13例（59.1%）含有肉芽肿，而44例对照组中只有3例（P<0.0001）。间隔期阑尾切除病例中有8例（36.4%）出现黄色肉芽肿性炎症，而急性阑尾炎组中无一例出现（P<0.0001）。11例间隔期阑尾切除病例中有11例（50.0%）呈现克罗恩样外观，对照组中有1例（P<0.0001）。11例具有克罗恩样特征的病例中有8例可获得随访数据；在平均23个月的随访期内，无一例发展为克罗恩病。延期或间隔期阑尾切除标本通常具有特征性的炎症模式，包括肉芽肿、黄色肉芽肿性炎症、壁层纤维化/增厚和透壁性慢性炎症。若无适当的临床病史，这些改变可能被误诊为克罗恩病。
