Morphometric Characteristics of the Vermiform Appendix and Their Histopathological Correlation in Adult Patients Undergoing Appendectomy for Acute Appendicitis: A Prospective Observational Study

Abstract

Background: The vermiform appendix demonstrates considerable variation in length, diameter, position, and wall morphology, while acute appendicitis produces characteristic inflammatory changes that may alter its gross dimensions. Data integrating appendiceal morphometry with histopathological severity are limited in South Asian populations.

Objective: This study was conducted to determine the morphometric characteristics of the vermiform appendix in adults undergoing appendectomy for clinically suspected acute appendicitis and to evaluate their relationship with histopathological findings.

 Methods: This prospective observational study was conducted at multiple tertiary-care teaching hospital in Pakistan over 12 months. Adult patients undergoing appendectomy for clinically suspected acute appendicitis were consecutively enrolled. Following removal, appendix length, external diameter at the base, middle and tip, and anatomical position were recorded using a standardized proforma. Representative tissue sections were fixed in 10% buffered formalin, processed routinely, stained with hematoxylin and eosin, and examined microscopically. Histopathological severity was categorized according to the predominant inflammatory pattern.

 Results: Among 180 patients, the mean age was 29.4±10.8 years and 109 (60.6%) were males. Mean appendiceal length was 7.2±2.0 cm and mean maximum external diameter was 10.1±2.4 mm. Retrocecal position was most frequent (43.9%). Acute suppurative appendicitis was the commonest histological diagnosis (51.1%). Increasing appendiceal diameter was significantly associated with increasing histopathological severity (p<0.001), whereas length showed no significant association (p=0.29).

Conclusion: Appendiceal diameter showed a stronger relationship with inflammatory severity than appendiceal length. Simple gross morphometry combined with routine histopathology provided useful anatomical and pathological information using inexpensive methods suitable for resource-limited settings.