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Acute appendicitis: are we over diagnosing it?

V Singhal1, V Jadhav

  • 1Department of Surgery, George Eliot Hospital NHS Trust, Nuneaton, UK. singhalvik@yahoo.co.in

Annals of the Royal College of Surgeons of England
|November 15, 2007
PubMed
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Laparoscopic appendicectomy is common, but normal-looking appendices are often removed, especially in females. Histology reveals other pathologies in many cases, suggesting diagnostic laparoscopy for females before appendicectomy.

Area of Science:

  • General Surgery
  • Surgical Pathology

Background:

  • Appendicectomy is a frequent emergency general surgical procedure.
  • Laparoscopic appendicectomy is increasingly common.
  • The decision to remove macroscopically normal appendices warrants investigation.

Purpose of the Study:

  • To compare macroscopic and microscopic findings of removed appendices.
  • To evaluate the utility of appendicectomy, particularly in cases with normal-appearing appendices.
  • To assess differences in appendiceal pathology between sexes.

Main Methods:

  • Retrospective study of 199 appendicectomies (open and laparoscopic) over one year.
  • Review of histopathology results and comparison with macroscopic descriptions.
  • Analysis of findings based on patient sex.

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Main Results:

  • Histopathology confirmed appendicitis in 81.2% of males and 51.8% of females.
  • A higher proportion of macroscopically normal appendices were removed from females.
  • Histological examination of 'normal' female appendices revealed other pathologies in 27 of 49 cases.

Conclusions:

  • Macroscopically normal appendices are more frequently removed in females.
  • Histological findings in 'normal' appendices suggest potential missed diagnoses or that the appendix was indeed the source of pain.
  • Diagnostic laparoscopy is recommended for all female patients prior to appendicectomy to identify alternative pathologies.