IS ACUTE APPENDICITIS DIFFERENT IN PATIENTS WITH SICKLE-CELL DISEASE

Nine patients with sickle cell disease (SCD) were operated upon at our hospital for acute appendicitis, comprising only 0.43% of the total a ppendicectomies performed at our institution. Three appendices were ac utely inflamed and six (66.7%) were perforated. Histologic evaluation of the six perforated specimens revealed congestion and haemorrhage by sickled erythrocytes (RBCs) in addition to acute transmural inflammat ory cell infiltrates. The mucosa was extensively ulcerated, with haemo rrhage both within the lumen and in the appendiceal wall. The blood ve ssels were dilated and packed with sickled RBCs. Two of the three acut ely inflamed appendices showed features of acute transmural appendicit is, with marked congestion and haemorrhage by sickled RBCs. The third did not show any acute inflammatory cell infiltrate, however, the muco sa was partly ulcerated with both mucosal and intraluminal haemorrhage . These findings suggest that acute appendicitis is different in patie nts with SCD: while it is not common, when it does develop it has a ra pid course with a high incidence of perforation due to blockage of app endiceal vessels by sickled RBCs, leading to transmural necrosis.