A high coincidence rate of the acute appendicitis, especially in the case of the perforation and other complications, and the appendiceal 'stones' is commonly known. However, what is known about why and how the appendicoliths are forming nowadays?
Several points come to mind:
1) An appendix with normal peristalsis probably will remain empty unless somehow a real foreign body (pin, buckshot) happened to become lodged inside it.
2) With altered or diminished peristalsis the appendix may never completely empty which probably allows for concretions to form and enlarge in lamellar fashion. Adhesions may interfere with peristalsis. Inadequate peristalsis may be inherited.
3} The appendix and gallbladder are both blind sacs and appear to share similar pathophysiological traits.
4) The incidence of appendicoliths in our area is poorly documented as the appendix is usually washed out during preparation for the pathologist. So the role of appendicoliths remains under-documented and under-appreciated.
5) I recommend opening the resected appendix to document the findings in the operative report before sending the appendix to pathology.
Dr.Aanning,
It's you who started this undoubtfully usesul dialogue at Researchgate!
However, every point was written in the subjective mood: 'probably', 'may', 'appear'.
The 'foreign body' theory as the cause of the acute appendicitis was coined by Conheim as early as in the end of the 19th century, if I remember correctly. In other words, a theoretical basis of the acute appendicitis pathogenesis mostly remains the same. Why so?
I am going to speak up a terrible thing: that is why to cut the appendix off is much simplier and cheeper than to study its physiology in proper way!
Demand borns supply everywhere, and Medical Science is not an exception. It is sadly enough, but there has been no demand for the acute appendicitis pathogenesis to investigate since the appendectomy became a routine and relatively simple procedure in the beginning of the 20th century, when surgeons-scientists were shifted by surgeons-practitioners in the acute appendicitis treatment.
I can recollect my faint attempts in the 90th to persuade my hospital endoscopists to try endocolonic access in the acute appendicitis patients so that to remove the incarcerated appendicolith. Invane! They said: 'It is dangerous! There is no experimental evidence! There is a routine surgical appendectomy to perform! That kind of endoscopy is the existing medical standards violation!' and so on, and so on... They might be right, moreover, they WERE right. But progress in medicine is always some kind of risque...
And I hope still that causes of this common disease will be pin down precisely in future, and the appendectomy will become rarity, and millions of people in the whole world will be left in peace and health whatever it may cost. There have appeared some articles on the conservative management of the AA already. For example, one can see:
[Davies S, Peckham-Cooper A, Sverrisdottir A. / Case-based review: conservative management of appendicitis--are we delaying the inevitable? // Ann R Coll Surg Engl. 2012 May;94(4):232-234].
Dr, Borodach!
I agree with you: how could anyone miss the opportunity to get immediate feedback from opening and examining a freshly resected appendix? Beats me!
Perhaps you are correct in your observation that surgeon-scientists have largely been replaced by surgeon-practitioners!
Seemingly, a percentage of opened appendixes may be increased if note that the appendix obturation may be caused by a accidently swallowed diamond :)) I know a surgeon which found such thing.
One reason not to open the appendix is that the histopathological examination of transversal slices is easier to perform for the pathologist.
I cannot see any difference from this point of view whether the appendix opened or not, if the appendix put with the mucosa down on a piece of paper so that its proper position could be recognised by a pathologist.
Besides, our pathologists make just one slice of a given appendix as a rule unless they suspect a malignancy.
For the past 40 years I have incised the inflamed or normal-appearing appendix immediately over any firmness to confirm the presence of an appendicolith or foreign material, and this is then documented in the operative report. I confess that no pathologist has ever reprimanded me for doing this maneuver - and none has ever suggested that it has made their examination of the appendix any more difficult.
I remain convinced that the presence or absence of an appendicolith, fecaloma, or other accretion in the lumen of the appendix is better documented in the surgeon's operative report than in the pathologist's report. And that therefore the incidence and the significance of appendicoliths is probably under-appreciated.
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