Changing trends in appendiceal pathology: a 16-year retrospective extension study of surgically removed appendices in a tropical teaching hospital

Abstract

BACKGROUND: The vermiform appendix is prone to various diseases, with acute appendicitis (AA) being the most common. The increasing incidence in Nigeria complicates diagnosis, leading to negative appendectomies. Accurate and timely diagnosis, along with routine histopathological examination, is essential for effective patient care. AIM AND OBJECTIVES: To investigate changes in the pathology of surgically removed appendix tissue from our center over 16 years, establish temporal trends in the incidence of appendicitis, and determine if findings regarding appendiceal pathology hold over time. MATERIALS AND METHODS: This study analyzed appendectomy samples obtained between 2008 and 2023 at Lagos University Teaching Hospital (LUTH), Nigeria. Emergency, incidental, and interval appendectomies were included; incomplete records were excluded. The samples were fixed in formalin, sectioned, stained, and examined to confirm the histopathological diagnosis. Special stains were applied for unusual findings. RESULTS: This study analyzed 1,467 appendicectomy specimens with a sex ratio of 1.25:1 and a mean age of 24.3 years (range: 4 days-94 years). The 10-19 years age group had the highest proportion (22.8%). Most surgeries were emergencies (72.0%), with 52.5% confirmed as AA, and perforation was most frequent in the 10-19 age group. Other findings included lymphoid hyperplasia (29.4%) and a 7.6% negative appendectomy rate. The number of appendectomies varied annually, with a decline in total cases and confirmed AA cases from 2020 to 2023. CONCLUSION: This 16-year review reveals evolving trends in appendiceal pathology at a tropical tertiary center, including an increase in younger patients, a reduction in sex disparity, and improved diagnostic accuracy. While AA remains predominant, frequent unexpected findings underscore the value of routine histological examinations.