Incidence and outcomes of unexpected pathology findings after appendectomy

Purpose: Pathologic evaluation of the appendix after appendectomy is routine and can identify unexpected findings. We evaluated our experience in children undergoing appendectomy to review the clinical course of patients with unexpected appendiceal pathology. Methods: After IRB approval, a retrospective review was conducted on patients who underwent appendectomy from January 1, 1995 to March 1, 2011. Patient demographics, diagnosis, pathological findings, disease outcomes, and treatment were collected only on patients with abnormal pathology. Results: 3602 patients underwent appendectomy. 113 patients had normal appendices, and 86 patients had unexpected findings, including carcinoid tumor (n = 9), pinworm (n = 34), granuloma (n = 14), eosinophilic infiltrates (n = 18), and other (n = 11). All cases of carcinoid tumor were completely resected, with no recurrence or need for reoperation. Of the 34 patients with pinworm infestation, 41.2% underwent antimicrobial therapy, and none had post-operative symptoms. One patient (7%) with an appendiceal granuloma developed Crohn's disease. Three patients (16.7%) with eosinophilia developed symptomatic intestinal eosinophilia. Conclusions: Pediatric appendiceal carcinoid is an incidental finding; in this series, none required further intervention. Appendiceal granulomas are not commonly associated with developing Crohn's disease in the short term. Routine antibiotics for the treatment of pinworms are adequate. Patients with appendiceal eosinophilia may develop symptomatic intestinal eosinophilia. (C) 2014 Elsevier Inc. All rights reserved.