Appendicitis is the most common intra-abdominal condition that required on emergency operation, it has a 6% lifetime risk. Approximately 60 per cent of the cases are related to hyperplasia of the submucosal lymphoid follicles, 35 per cent to the
presence of fecal stasis or a fecalith, 4 per cent to the presence of other foreign bodies, and 1 per cent to strictures or tumors of the wall of the appendix or the cecum. In addition to the findings of acute inflammation, the excised appendix
can
be
the site of a variety of neoplasms and unusual inflammatory conditions. We analyzed 20 patients who received emergent appendectomy but were diagnosed with an uncommon diseases in the appendix between 1985 and 1990. Six patients had chronic
granulomatous
inflammation, 4 carcinoid tumors, 3 cases each of primary adenocarcinoma and mucocele, and one case each of malignant lymphoma, adenomatous polyp, chronic fibrosis, and diverticulitis. The period from the onset of symptoms to the time of
operation
was
longer than acute appendicitis, taking more than 5 days in 10(50%) patients. Typical complant of pain shifting toward the right lower quadrant occurred in 40 per cent(8/20). Tenderness, and muscle guarding were not severe, except in the cases
with
perforation. Perforation occurred in 9 patients(45%), 3 who had primary adenocarcinoma, 2 in chronic granulomatous inflammation, 2 in mucocels and one each in carcinoid tumor and diverticulitis and was higher than 27% in acute appendicitis. The
white
blood cell count increased in 14 patients(70%), which was not significantly different from acute appendicitis. Appendectomy was performed in 11 patients and right hemicolectomy was done in 3 cases each of adenocarcinoma and chronic granulomatous
inflammation and on case of malignant lymphoma. Reoperation was performed in 4 cases. Gross findings in the appendix were somewhat discreet against acute appendicitis especially in carcinoid tumors which had the appearances of edematous
enlargement
and
hardness and in mucoceles with broad bases of appendix. In conclusion, we should keep in mind unusual conditions for accurate diagnosis and treatment when e decide to operate for acute appendicitis.
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