Studies on the Classification and Related Pathological Findings of Appendicitis

Keimyung Medical Journal 1987;6(2):222-240.

충수돌기염의 분류와 병변에 관한 연구

김선영; 정재홍

Abstract

Appendicitis is still one of the serious acute abdomen at the moment which requires prompt surgical intervention with high attack rate and considerable complications. Current pathological classification of the appendicitis is least not satisfactory. And the pathogenesis of which is not clearly elucidated yet. With this reason; the author has conducted a study to see if the newly revised Butler's classification is valid by reclassifying 804 cases of previously diagnosed materials of appendicitis stocked at the Keimyung University Dongsan Hospital; 1984 to 1987. Ultrastructural and bacteriological study of the acute appendicitis were carried out; specimens taken at the site of operation; to clarify the possible pathogenesis of the disease; on the materials of 19 and 36 cases; respectively. The results were as follows: 1. Reclassified 804 cases of appendicitis showed following findings: acute early appendicitis; 6 cases; acute simple appendicitis; 126 cases; acute suppurative appendicitis; 257 cases; acute gangrenous appendicitis; 68 cases; acute perforated appendicitis; 169 cases; acute and chronic appendicitis; 42 cases; and chronic appendicitis;6 cases. 2. It appears that the perforation observed in acute appendicitis is the consequences of transmural necrosis; the latter being induced by both suppurative liquefactive burrowing and infarction. 3. In the case of acute and chronic appendicitis; one can find a focus of granulation tissue with or without fibrosis surrounded by a field of acute appendicitis lesion. With this histologic findings; one can surmise that fibrous obliteration of the appendix may be a sequelae of acute appendicitis. 4. The bacteriological study showed that most frequent bacterial growth is E. coli and Bacteroides group which are normal flora one can find in the intestine. 5. Massive exudate outside of the blood vessels in the inflammatory focus with a feature of leukocytic emigration along with a finding of thrombosis is well illustrated by TEM. Reduced number of microvilli; swollen and stubby; are found in the case of acute early appendicitis by SEM. Suppurative changes of the appendiceal mucosa also can be demonstrated along with ? asaa: ma m% microorganisms in the advanced lesion. - 223 - It is; therefore; concluded that newly revised classification of appendicitis is considered adequate and bacteriological study failed to establish a prevailing concept of microorganism etiology. It appears that SEM study of the appendicitis lesion may be more rewarding than that of TEM.