The Significance of Eosinophils in Acute Appendicitis: A Comparative Study

Abstract

Background: Acute appendicitis is one of the most common abdominal emergencies worldwide. Bacterial infection is the most common cause. Even though it is rare, acute eosinophilic appendicitis (AEA) is an overlooked entity by both clinicians and histopathologists in Sri Lanka that may contribute to the clinical presentation of acute appendicitis. Objectives: This study aimed to evaluate the prevalence of AEA compared to a control group from post-mortem cases unrelated to sepsis and to increase awareness among clinicians to consider it in the differential diagnosis and the possibility of treating medically in addition to usual treatment with antibiotics. Methodology: Previously reported appendectomy cases (N=257) were reassessed by two histopathologists blinded to each other. The frequencies of possible causes of all cases with concordant diagnoses were compared to the control group. Fisher’s Exact Test was used to compare the prevalence of AEA between groups. Results: Acute eosinophilic appendicitis was identified in 16/257 (6.22%) of the study group and in 0/100 (0%) of the control group. The difference in prevalence was statistically significant (Fisher’s Exact Test, p = 0.0045), supporting AEA as a probable cause for clinical appendicitis. Conclusions and Recommendations: AEA may represent an overlooked contributor to acute appendicitis. As it is a type I hypersensitivity reaction, there is a possibility of treating it medically.  Increased recognition of this entity could be considered as a hypothesis and develop more studies on it to reduce surgical interventions. Clinical trials by surgeons may value further validating these findings. This is a flatform for future studies and invention of novel investigations on that.