The value of routine histopathological examination of appendicectomy specimens

Histopathology reports for all appendices analysed at the NNUH between March 2003 and March 2006 were reviewed by examination of the case notes. The analysis focussed on the confirmation of acute appendicitis, incidental unexpected incidental findings other than inflammation, whether these abnormalities were suspected on gross examination at the time of surgery, and the effect on patient management and prognosis.The histopathology reports disclosed a variety of abnormal incidental lesions. Of the 1225 specimens, 46 (3.75%) revealed abnormal diagnoses other than inflammatory changes. Twenty-four (1.96%) of these were clinically significant and affected further patient management. Only two of these (0.16%) were suspected on macroscopic examination intra-operatively.Twenty-four of the 1225 specimens (1.96%) had an impact on patient management or outcome and were not suspected on macroscopic examination at the time of surgery. These would have been missed had the specimens not been examined microscopically. The intra-operative diagnosis of the surgeon is therefore unreliable in detecting abnormalities of the appendix. This study supports the sending of all appendicectomy specimens for routine histopathological examination.Acute appendicitis is the most common general surgical emergency [1]. In England 42,526 patients underwent appendicectomies in the year 2004–5 with a mean age of 28 years [2]. Approximately 20% of those undergoing appendicectomes are found not to have acute appendicitis at surgery [3-6], with this being more common in females than males and approaching a ratio of 3:1 in the 15–19 age group [7].Clinical findings form the basis for diagnosis which may be consolidated by blood tests such as C-reactive protein and white cell count, and management is early appendicectomy [8]. The practice of sending appendicectomy specimens for histopathological analysis varies [9]. Whereas it is recognised that many resected specimens in general surgery need not be sent, t