How do the microscopic findings change from the early stages to the later stages of appendicitis?

Updated: Jul 23, 2018
  • Author: Sandy Craig, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

In the early stages of appendicitis, the appendix grossly appears edematous with dilation of the serosal vessels. Microscopy demonstrates neutrophil infiltrate of the mucosal and muscularis layers extending into the lumen. As time passes, the appendiceal wall grossly appears thickened, the lumen appears dilated, and a serosal exudate (fibrinous or fibrinopurulent) may be observed as granular roughening. At this stage, mucosal necrosis may be observed microscopically.

At the later stages of appendicitis, the appendix grossly shows marked signs of mucosal necrosis extending into the external layers of the appendiceal wall that can become gangrenous. Sometimes, the appendix may be found in a collection of pus. At this stage of appendicitis, microscopy may demonstrate multiple microabscesses of the appendiceal wall and severe necrosis of all layers.


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