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Patología Revista Latinoamericana

2013, Number 1

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Patol Rev Latinoam 2013; 51 (1)

Acute appendicitis with fibrous obliteration of the tip and mural inclusion of foreign body (the paradox of the xenorreactive anergy). Case report

Salazar-Morales MF, Caballero-Hernández SE, Estrada- Hernández MR

Language: Spanish
References: 16
Page: 34-40
PDF size: 433.54 Kb.


ABSTRACT

We report a case of foreign body appendicitis (pin) with evidence of rupture and fibrous obliteration along with a brief bibliographic review emphasizing the paradoxical lack of foreign body reaction.
Case. A 66-year-old man with symptoms suggestive of appendicitis. Plain abdominal radiographs showed a radiopaque object in the right lower quadrant. Appendectomy was performed.
Results. A ruptured appendectomy specimen with adherent white plaques was received. The lumen was occupied by fecal matter and the distal end obliterated by fibrous tissue. Serial cuts disclosed an inserted mural pin enveloped by organized tissue. Histological examination showed ulceration, extensive neutrophil infiltration, necrosis and perforation. The appendiceal tip lumen was replaced by fibrous and connective tissue proliferation with cells positive for neuroectodermal and neuroendocrine markers (S100, NSE and synaptophysin).
Conclusion. Appendiceal foreign bodies are rare findings which not necessarily lead to perforation. The lack of foreign body reaction may depend of complex interactions between the inflammatory response and the physicochemical properties of the material´s surface (Vroman effect, TH2 citokines, macrophage fusion, etc). Fibrous obliteration of the vermiform appendix is, apparently, not related to the foreign body presence.


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