Keywords

Appendix; Appendectomy; Incidental; Bowel; Cancer; Nigeria

Introduction

Incidental appendectomy is of worldwide interest [1,2]. Concerning it, publications from this center referred to whether it is useful during ectopic tubal excisions [3] and also how it relates to ovariectomy for teratoma [4]. Accordingly, this paper documents related cases found during colectomy for cancer among the Ethnic Group called the Igbos of South-Eastern Nigeria, West Africa [5]. This is possible because, as a Birmingham (UK) group stated, the establishment of a histopathology data pool facilitates epidemiological analysis [6].

Investigation

From 1970, after the Nigerian Civil War subsided, the author was privileged to be the pioneer pathologist at the Eastern Regional Pathology Laboratory. This provided the opportunity to collect biopsy specimens from practitioners, the only conditionality being their supply of useful clinical details. The cases have been manually retrieved and analyzed with reference to those in whom the performance of colectomy for cancer was combined with appendectomy.

Result

Table 1 shows broadly that bowel carcinoma is much commoner in males and among the younger elements, seeing that the ages ranged from 30 to 66 years (mean 44 years). It was uncommon to come across a normal appendix, the majority displaying chronic cell infiltration of the subserosa. The incipient phase was apparent in the 2 cases in which crypt abscess formation had occurred.

Table 1: Age/sex distribution and appendix lesions.

Discussion

Case 12 was unique in that it raised the question of whether the appendix was the primary or secondary site. Unfortunately, this could only be determined by follow-up of the patient, a maneuver which was not possible in the local setting. Exner’s group reviewed 380 cases of this combination conclusively [7]. In contrast, there was the submission from Thailand; the research was on the incidence of synchronous appendiceal neoplasm in patients with colorectal cancer [8]. However, their appendix case was not cancer but the benign mucinous cystadenoma as well as metastases in the mesoappendix.

Incidentally, there was debate in the UK with regard to whether distant hospitals benefit fcrom reports emanating from a central institution [9]. Our local experience contradicts this idea [10].

Interestingly, a group ruled out incidental appendicectomy in the elderly [11]. However, two of the local patients were in this category. Unfortunately, the present series was such that follow-up was not possible.

References

1. Snyder TE, Selanders JR (1998) Incidental appendectomy-Yes or no? A retrospective case study and review of the literature. Infect Dis Obstet Gynecol 6: 30-37.
2. Tartaglia D, Galatioto C, Palmeri M (2016) Incidental appendectomy? Microscopy tells another story: A retrospective cohort study in patients presenting acute right lower quadrant abdominal pain. Intl J Surg 28: 149-152.
3. Onuigbo WIB (1977) Elective appendectomy at salpingectomy for ectopic pregnancy: Is it desirable? Obstet Gynecol 49: 435-438.
4. Onuigbo WIB (2016) Epidemiologic perspectives of incidental appendectomy during ovariectomy for teratoma in a developing community, Nigeria. J Pharm Res 1: 1-2.
5. Basden GT (1966) Niger Ibos. Cass, London.
6. Macartney JC, Rollaston TP, Codling BW (1980) Use of a histopathology data pool for epidemiological analysis. J Clin Pathol 33: 351-353.
7. Exner R, Sachsenmaier M, Horvath Z (2012) Incidental appendectomy-standard or unnecessary additional trauma in surgery for colorectal cancer? A retrospective analysis of histological findings in 380 specimens. Colorectal Dis 14: 1262-1266.
8. Lohsiriwat V, Vongjirad A, Lohsiriwat A (2009) Incidence of synchronous appendiceal neoplasm in patients with colorectal cancer and its clinical significance. Wld J Surg Oncol 7: 1-4.
9. Lilleyman J (2002) From the President. Bull Roy Coll Pathol 117: 2-3.
10. Onuigbo WIB, Mbanaso AU (2005) Urban histopathology service for a remote Nigerian hospital. Bull Roy Coll Pathol 132: 32-34.
11. Nockerts SR, Detmer DE, Fryback DG (1980) Incidental appendectomy in the elderly? No. Surgery 88: 301-306.