Appendicitis and Ligneous Perityphlitis

Introduction  "Ligneous perityphlitis," "ligneous cecitis," "chronic perityphlitis," "periappendiceal granuloma," "granuloma of the ileocecal region secondary to appendicitis," and other terms have been used to describe an unusual inflammatory and fibrotic process of the periappendiceal and pericecal tissues which often is tumefactive and grossly confused with carcinoma either clinically or at operation. The grossly ligneous ("woody") nature of this condition has been variously described as caused by degrees of fibroblastic proliferation with acute, subacute, or chronic (or both) inflammatory reaction, and with the occasional presence of giant cells. This process is at variance with the usual concept of appendicitis. In the literature, "granuloma" has been used more to designate the gross characteristics of an inflammatory tumor than to denote a histopathologic epithelioid response in this condition.The history of appendicitis has been well-covered by Collins.² The terms "typhlitis" or "perityphlitis" were originated because earlier writers believed that the inflammation began