Our Summary

This research paper reviews cases of granulomatous appendicitis (GA) - a rare type of appendicitis - in children from two large pediatric institutions. GA was found in 0.4% of the patients, with the average age being around 12 years old. Half of these cases had a severe type of appendicitis which was treated with medication before removing the appendix at a later time.

Among the remaining cases that had the appendix removed immediately, only one was found to have Crohn’s disease - a chronic inflammatory bowel condition. None of the other patients were later diagnosed with any inflammatory bowel disease.

The study also found that the granulomas, or inflammation, in the appendix tended to be more on the outer layer (serosal) rather than the inner layer (mucosal) in cases where the appendix was removed at a later date. Staining techniques used to identify infectious microorganisms in GA did not help in treatment decisions.

In the same period, GA was found in 6% of bowel removal surgeries due to Crohn’s disease. Therefore, the study concludes that GA is uncommon in children and is usually not associated with Crohn’s disease. The presence of infectious organisms in GA has little effect on how these cases are managed.

FAQs

  1. What is the prevalence of granulomatous appendicitis (GA) in pediatric patients?
  2. Is granulomatous appendicitis in children often associated with Crohn’s disease?
  3. How useful are special stains for infectious organisms in the diagnosis and management of granulomatous appendicitis in children?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pediatric appendectomy is to follow up with the surgeon regularly after the procedure to monitor for any signs of infection or complications. It is also important to follow any post-operative instructions provided by the medical team, including taking prescribed medications and avoiding strenuous activities until fully healed. If there are any concerns or changes in symptoms, it is important to contact the healthcare provider immediately.

Suitable For

Pediatric patients who are typically recommended for pediatric appendectomy are those who present with symptoms of acute appendicitis, such as abdominal pain, fever, and nausea/vomiting. In the case of granulomatous appendicitis, patients may also undergo interval appendectomy if they have perforated appendicitis that was initially managed medically. It is important to consider the possibility of other underlying conditions, such as Crohn’s disease, in patients with granulomatous appendicitis. Special stains for infectious organisms may be performed during appendectomy, but they have low diagnostic yield and little impact on clinical management.

Timeline

Before pediatric appendectomy:

  • Patient presents with symptoms of appendicitis such as abdominal pain, fever, nausea, and vomiting
  • Diagnostic tests such as physical examination, blood tests, and imaging studies are performed to confirm the diagnosis
  • In cases of complicated appendicitis, such as perforation, patients may receive medical management prior to surgery
  • Interval appendectomy may be recommended for some patients after initial medical management

After pediatric appendectomy:

  • Surgery is performed to remove the inflamed appendix
  • Pathology report shows the presence of granulomatous appendicitis in some cases
  • Follow-up appointments are scheduled to monitor recovery and assess for any complications
  • In cases where Crohn’s disease is identified during surgery, further management and monitoring may be necessary
  • Special stains for microorganisms may be performed, but are of low diagnostic yield and have little impact on clinical management
  • Long-term follow-up may be recommended to monitor for any signs of inflammatory bowel disease or recurrence of appendicitis.

What to Ask Your Doctor

  1. What is the likelihood of my child having granulomatous appendicitis compared to other types of appendicitis?
  2. What are the potential causes of granulomatous appendicitis in children?
  3. Are there any specific symptoms or signs that may indicate granulomatous appendicitis in pediatric patients?
  4. How is granulomatous appendicitis diagnosed in children?
  5. What is the recommended treatment approach for pediatric patients with granulomatous appendicitis?
  6. Are there any long-term implications or complications associated with granulomatous appendicitis in children?
  7. Is there a need for further testing or monitoring after the appendectomy procedure?
  8. Are there any dietary or lifestyle recommendations to follow after surgery for granulomatous appendicitis in children?
  9. Are there any genetic or familial factors that may increase the risk of granulomatous appendicitis in children?
  10. Are there any specific precautions or measures to take to prevent recurrence of granulomatous appendicitis in pediatric patients?

Reference

Authors: Wu H, Fuller MY, Pogoriler J. Journal: Pediatr Dev Pathol. 2020 May-Jun;23(3):215-221. doi: 10.1177/1093526619881545. Epub 2019 Oct 16. PMID: 31619135