Pseudo-appendictis is used to describe condition that maymimic clinical symptoms of appendicitis without having the presence of aninflamed appendix. Bacteria causing diarrhea in humans,spirochetes inwhich case the infection is confined to the ileocecal area or intestinal muralpathology cause an appendicitis-mimicking syndrome.
Pseudo-appendicitis is a false appendicitis. Signs andsymptoms mimic classical signs of appendicitis and patients erroneouslylabelled as having this acute abdominal emergency. Up to 17 percent ofappendectomy specimen on histopathology do not show the pathogenicfeatures of acute appendicitis and arelabelled as pseudoappendicitis. Presence of commonly elicited signs inappendictis are replica in pseudoappendicitis.Tenderness, rebound tendernessand McBurney’s sign are physical signs present akin to those present in patienthaving appendicitis. In these patients right lower abdominal pain is the cardinalsymptom diarrhea being absent or only mild. Symptomatology suggests that thisotherwise innocuous and self-limiting condition may lead to an unnecessarylaparotomy for suspected appendicitis. Infectious cause of pseudoappendicitisare Yersinia enterocolica, Yersinia pseudotuberculosis, Campylobactercolitis,Plesiomonas shigelloides ,intestinal spirochetosis,SalmonellaHeidelberg,Parvovirus B19 and infectious mononucleosis.Intestinal muraldiseases like Crohns disease, small bowel hematoma and Caecal wall hematoma areconsidered to elicit signs similar to appendicitis leading topseudoappendictis. Pseudoappendicitis of Thoracic spine dysfunction and ofnuerosurgical origin have been reported to present as pseudoappendicitis.Enlarged mesenteric lymph nodes or ileocecal wall thickening are often subtleand easily missed as their farther location from gut border in the mesentery,meagre palpation through the grid-iron incision may contributory to getunnoticed intra-operatively which are present in pseudoappendictis mainly.Often, abundance of mesenteric fat and nodes embedded in them makes their palpationdifficult. Significantly enlarged lymph nodes are easily palpable,earning nameof mesenteric lymphadenitis.
Yersinia enterocolitica and Pseudo-tuberculosis arepathologic to man and these bacteria are be isolated in ponds and the soil.People who exhibit poor personal hygiene may be at an increased risk ofinfection. Y enterocolitica is present virtually in in all species of animalsincluding mammals and reptiles. Mode of transmission is direct contact andingestion of contaminated material, water and food. Consumption of pork,ingestion of unpasteurized cow’s milk, contaminated fresh eatables likecarrots, tomatoes, lettuces, beetroot, radishes, parsley, cabbage, mushrooms, celery, bananas, mixedsalads and Dairy products..After portal entry through oral route , lodge in theterminal ileum and multiply there.These percolate to mesenteric lymph nodesleading to mesenteric adenitis. Often this mesenteric adenitis mimic acuteappendicitis so cause pseudo-appendicitis. Most of the bacteria areconcentrated at the terminal ileum and causes localized adenitis mimickingappendicitis. Where Yesrinia Pseudo-tuberculosis have been implicated inPseudo-appendicitis, is suspected to occur from contaminated Salad commonly viainfested lettuce. Campylobacter have role in pseudo-appendicitisand their modeof transmission is via consumption of Campylobacter-infested eatables, withpoultry as a main reservoir of the disease. Unhygenic food-handling practicesis culprit in transmission of Campylobacter infections. Abdominalmanifestations of Epstein bar virus infection include mesentericlymphadenopathy, ileocolitis and so pseudo-appendicitis and even few cases oftrue appendicitis have been occured with this viral pathogen. P. shigelloideshas been isolated from humans with pseudo-appendicitis.This causes acutedysenteric or cholera like diarrhea and sometimes infestation mimicspseudo-appendicitis. Aeromonas infections are mostly community acquired due toexposure to freshwater or from eating raw fish. This infection can involve anypart of the colon, but most commonly affect transverse part and may leadsegmental colitis,presenting as pseudoappendicitis resulting in unnecessarysurgery.I n a hemophiliacs, a circumferential bowel wall hematoma withinterminal ileum may present as a case of pseudo-appendicitis diagnosed by CTscan with the initial diagnostic scan.Post vasectomy procedure has beenimplicated in pseudo-appendicitis and an unusual complication of vasectomy.
Dr Imtiaz Ahmed Wani is Surgeon Specialist, DHS, Kashmir