Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2021; 13(1): 76-86
Published online Jan 27, 2021. doi: 10.4240/wjgs.v13.i1.76
Xanthogranulomatous appendicitis: A comprehensive literature review
Sami Akbulut, Khaled Demyati, Cemalettin Koc, Adem Tuncer, Emrah Sahin, Mehmet Ozcan, Emine Samdanci
Sami Akbulut, Khaled Demyati, Cemalettin Koc, Adem Tuncer, Emrah Sahin, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Khaled Demyati, Department of Surgery, An-Najah National University, Nablus, 44839, Palestine
Mehmet Ozcan, Emine Samdanci, Department of Pathology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Author contributions: Akbulut S, Koc C and Demyati K designed the report; Tuncer A, Sahin E and Akbulut S performed the literature review; Ozcan M and Samdanci E provided the histopathological information; all authors reviewed the final version.
Conflict-of-interest statement: The authors declare no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sami Akbulut, MD, Professor, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, Malatya 44280, Turkey. akbulutsami@gmail.com
Received: October 11, 2020
Peer-review started: October 11, 2020
First decision: November 3, 2020
Revised: November 12, 2020
Accepted: December 1, 2020
Article in press: December 1, 2020
Published online: January 27, 2021
Processing time: 94 Days and 11.4 Hours
ARTICLE HIGHLIGHTS
Research background

Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes, plasma cells, neutrophils, and often multinucleated giant cells with or without cholesterol clefts

Research motivation

Although a limited number of case reports on xanthogranulomatous appendicitis (XGA) have been published to date, no systematic literature analysis has been conducted.

Research objectives

The main objective of this study was to review the articles published in the medical literature on XGA. A secondary objective of this study was to present the medical history of a female patient diagnosed with XGA.

Research methods

A systematic literature search was conducted on PubMed, Medline, Google Scholar, and Google databases using the following keywords: Appendix vermiformis, acute appendicitis, XGA, interval appendectomy, and appendectomy. The search included articles published before May 2020, and the publication language was not restricted.

Research results

A total of 29 articles involving 38 patients with XGA, were retrospectively analyzed. A total of 38 patients, 20 (52.6%) female and 18 (47.4%) male, aged from 3 to 78 years were included in this study. Fifteen patients' WBC values were reported, and 13 (86.7%) of them had leukocytosis. Twenty-five patients were diagnosed with acute appendicitis, ruptured appendicitis, or subacute appendicitis, and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region. Twenty-two of the patients underwent urgent or semi-urgent surgery, and the remaining 16 patients underwent interval appendectomy.

Research conclusions

Xanthogranulomatous inflammation rarely affects the appendix vermiformis. It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation. It is often associated with interval appendectomies, and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion.

Research perspectives

A review of the literature and our experience of appendiceal diseases suggest that XGA is usually identified after histopathological examination of the appendectomy specimen and XGA has no unique features in preoperative diagnostic studies. Therefore, the most important factors regarding the preliminary diagnosis of XGA are surgeon's experience, clinical suspicion and intraoperative findings.