Wonders in Appendix – A Case Series

Introduction: Appendix is a true diverticulum arising from cecum; prone for inflammation. Acute appendicitis is the commonest surgical emergency operated word-wide, with fecolith induced luminal obstruction is the frequent cause; however unforeseen causes can amaze both surgeon and pathologist. We report a case series on the rare etiologies for acute appendicitis. Out Material & Methods: Result: of 383 cases of appendectomy specimens, we are reporting a case series on unconventional morphological findings (n=14) in alleged vestigial appendicectomy specimens accounting for 3.65%. These are: Acute appendicitis with worm infestation; Enterobius vermicularis (1.04%), Appendicular neuroma (1.04%), Carcinoid (0.26%), Schwannoma (0.26%), Primary Mucinous neoplasm of appendix (0.78%) and metastatic lesion (0.26%). Discussion: Luminal obstruction by fecolith (60-65%) is the most common cause for acute appendicitis. However, incidental association of parasites especially E. vermicularis (0.2-4.8%) and E. histolytica (0.5-2.3%) can be seen in the lumen along with predominantly eosinophilic infiltration in the wall. The appendiceal neuroma (<1%) causing proliferation of neural tissue, obliterating the appendiceal lumen thus mimicking as acute appendicitis. The association of neoplastic lesions like appendicular carcinoid (0.3-0.9%), mucinous neoplasms, appendiceal schwannoma (0.6-0.8%) and metastatic deposits into appendiceal wall (0.2-0.7%) are the other rare causes masquerading as appendicitis. Conclusion: Wonders in appendix are unconventional entities can be presented as surgical emergencies requiring immediate interventions and can be missed easily if morphology is studied offhandedly. Awareness and careful morphological assessment of appendicectomy specimens is essential for further management of the patients.