FREQUENCY DETERMINATION OF NEGATIVE APPENDECTOMY AND UNUSUAL FINDINGS OF ACUTE APPENDICITIS: A RETROSPECTIVE STUDY

Abstract

Objective: To find out the frequency and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis and to ascertain the rate of negative appendectomy in multiple health care institutes of Pakistan.

Material & Methods: The epidemiological and pathological data of all the patients who were operated for the initial diagnosis of acute appendicitis between January 2015 and December 2015 was retrospectively evaluated. Histologically the cases were sub classified under four categories; acute appendicitis, lymphoid hyperplasia, unusual histopathological findings and negative appendectomy. The patient’s age, clinical history, sex, operative reports, histopathological reports were assessed.

Results: Total 1093 samples were collected during the study period, of which 755 were males and 338 females. Their age range was from 2 to 80 years. Amongst all the collected samples, 572 patients were operated because of acute appendicitis and 342 due to lymphoid hyperplasia. The appendectomy due to unusual histopathological findings was carried out in 55 patients and the most common cause was fibrous obliteration that accounted for 56 % (31/55). Negative appendectomy rate was found to be 10.8 % (119/1093).

Conclusion: Definite diagnosis of appendicitis and many unusual diseases is only possible histologically irrespective of the macroscopic appearance of appendectomy specimens and clinical presentation. Advancements in the diagnostic and imaging techniques have not significantly reduced the rates of negative appendicectomy. Clinical assessment outweighs other diagnostic modalities in the management of patients with suspected acute appendicitis.

Key Words: Appendicitis, Appendectomy specimens, Histopathology, Unusual findings, Appendiceal malignancy, Negative appendectomy.