Relationship between Pathological Findings of Surgical Specimen and Clinical Features in Patients with Acute Appendicitis

Akiyo Matsumoto, Susumu Nobusawa, Taihei Aoi, Fumio Aoki, Kazuki Yamazaki, Shingo Shikano, Teruo Katayanagi, Isao Kudo*, Masamitsu Shoji**

Department of Surgery, Yuai Memorial Hospital, *Division of Radiological Diagnosis, Yuai Memorial Hospital and **Division of Pathology, Yuai Memorial Hospital

We studied the relationship between the pathological severity of acute appendicitis and its clinical features in 211 patients with acute appendicitis encountered during the last 4 years. Based on the degree of increase in lymphatic follicles and the degree of invasion of neurotrophic cells in the appendix wall, the pathological severity was defined, as follows: mild cases were the catarrhal type, while severe cases were the phlegmonous and necrotic types. As a function of age, all young children and aged patients were severe. Concerning symptoms, a fever of 39.0°C or less correlated only with the necrotic type. In comparison with mild cases, severe cases more frequently experienced vomiting and constipation and suffered general abdominal pain or migrating pain. Although rebound pain was more frequently observed in severe cases, there were no significant differences in the incidence of a muscular defense reaction among the 3 histological types. The white blood cell (WBC) count was within the normal range in 10.0-27.6% of severe cases and correlated only with the necrotic type; however, the differential WBC count could be used as an indicator for the severity of this disease since 60% of severe cases had a WBC count of 10,000 cells/mm³ or less. Chest x-rays showed almost no characteristic features. Abdominal ultrasonic examination showed that the appendix was more frequently swollen in severe cases, and fluid was retained around the ileocecal part. Postoperative complications were not significantly different between mild and severe cases.

Key words
pathological severity, clinical features, acute appendicitis

Reprint requests
Akiyo Matsumoto The Department of Surgery, Yuai Memorial Hospital
726 Sekido, Sowa-cho, Sashima-gun, Ibaragi, 306 JAPAN

Accepted
November 20, 1991

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