Clinicopathological differences between patients with schistosomal appendicitis and non schistosomal appendicitis: A retrospectively study of past ten years.

Background: Chronic schistosomiasis causes multiple organ and multiple system diseases, especially the digestive system. Schistosome eggs are mainly deposited in the stomach, liver and colorectal, but a few eggs are deposited in the appendix and cause disease. At present, there are few studies on schistosomal appendicitis.

Aim: To explore the differences in epidemiological, clinical and pathological characteristics between schistosomal appendicitis and non-schistosomal appendicitis over the past decade in order to assess the impact of schistosomiasis on appendicitis.

Methods: The differences of general data, clinical data and laboratory examination data of patients with appendicitis from October 2013 to October 2023 were retrospectively analyzed. All patients were divided into two groups for analysis. There were 136 patients in schistosomal appendicitis group and 5418 patients in non-schistosomal appendicitis group.

Results: Schistosomal appendicitis accounted for 2.45% of all patients with appendicitis, and the annual proportion in the past decade was 2.2%, 2.9%, 1.8%, 1.9%, 3.4%, 3.1%, 1.9%, 1.6%, 3%, 2.6%, respectively. The prevalence of schistosomal appendicitis was middle-aged and elderly males, with an average age of 61.73 ± 15.335 years. The main population of non-schistosomal appendicitis was middle-aged men, with an average age of 35.8 ± 24.013 years (P < 0.001). The distribution of pathological types of appendicitis was different between the two groups (P < 0.001). The incidence of acute suppurative appendicitis in non-schistosomal appendicitis was higher than that in schistosomal appendicitis [odds ratio (OR) = 0.504; 95% confidence interval (CI): 0.349-0.728; P < 0.001]. The proportion of acute attack of chronic appendicitis in schistosomal appendicitis was higher than that in non-schistosomal appendicitis (OR = 2.614; 95%CI: 1.815-3.763; P < 0.001). The proportion of schistosomal appendicitis patients complicated with colorectal cancer was higher than that of non-schistosomal appendicitis patients (OR = 5.087; 95%CI: 1.427-18.132; P = 0.012). There was no difference in clinical symptoms between the two groups. In the laboratory examination, there was a significant difference in white blood cells between schistosomal appendicitis and non-schistosomal appendicitis. The level of white blood cells in schistosomal appendicitis group was slightly higher than the upper limit of the normal range. Other statistically significant indicators were in the normal range.

Conclusion: Schistosomal appendicitis is a severe condition that is often associated with intestinal malignancies, potentially leading to a poor prognosis. Schistosomal appendicitis is more likely to be misdiagnosed and missed diagnosed in clinical work because of its nonspecific clinical manifestations and laboratory examination. It is crucial to differentiate schistosomal appendicitis in middle-aged and elderly male patients presenting with appendicitis, and to ensure early detection and treatment.