Appendicular abscess pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Pathophysiology
- Obstruction of the tubular space inside the appendix is the main inciting event, this initial problem leads to the inflammation of the appendix, obstruction of the blood vessels supplying it, and finally infection. [1]
- Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its cellular components.[2]
- This leads to an increase in endoluminal and intramural pressure, which can result in an occlusion of the venules in the appendiceal wall resulting in thrombosis and occlusion and stasis of blood and lymphatic flow.
- The stasis favors the bacterial growth leading to infection of the appendix .
- Inflammatory mediators along with various bacterial toxins and proteolytic enzymes from the neutrophils are released, resulting in the formation of abscess in appendix.
Transmission
- The abscesses usually contain a mixture of aerobic and anaerobic bacteria from the gastrointestinal tract.
Duration
- The risk of perforation or abscess formation is negligible within the first 12 h of untreated symptoms, but then increases to 8.0% within the first 24 h.[1]
Gross Pathology
- The serosal surface of the appendix looks pale with rough edges and yellowish exudate along with hyperemia
Microscopic findings
- A focally necrotic appendiceal debris is seen in the mucosal wall.
- Intravascular fibrin is seen in medium-sized blood vessels.
- Clusters of neutrophils are seen on the serosal aspect.