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New morphological findings in so-called negative appendectomies

E Ring-Mrozik1, W C Hecker, B Wiebecke

  • 1Department of Pediatric Surgery, Dr. v. Haunersches Kinderspital, München, Germany.

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
|April 1, 1993
PubMed
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Revisiting pediatric appendectomies initially deemed normal revealed significant epithelial and lymphatic tissue changes in over two-thirds of cases. This redefines the concept of "negative appendectomy" in pediatric surgery.

Area of Science:

  • Pediatric Surgery
  • Surgical Pathology
  • Histology

Background:

  • The diagnosis of acute appendicitis in children often leads to appendectomy.
  • Histological examination of removed appendices is standard practice to confirm diagnosis.
  • A subset of appendectomies yields 'normal' histological findings, termed 'negative appendectomies'.

Purpose of the Study:

  • To re-evaluate appendices from children initially classified as histologically normal after surgery for acute appendicitis.
  • To compare these findings with cases of catarrhal and early phlegmonous appendicitis.
  • To determine if subtle pathological changes exist in 'negative appendectomy' specimens.

Main Methods:

  • Revision of appendiceal specimens from pediatric patients originally diagnosed with acute appendicitis but showing normal histology.

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  • Application of special assays to re-examine these specimens.
  • Comparative analysis with appendectomy specimens from patients with confirmed catarrhal and early phlegmonous appendicitis.

    • Main Results:

    • Pathological changes in the epithelium and lymphatic tissue were identified in over two-thirds of specimens previously classified as normal.
    • These findings suggest that initial histological assessments may overlook subtle abnormalities.
    • The prevalence of these changes indicates a need for re-evaluation of the 'negative appendectomy' classification.

    Conclusions:

    • The term 'negative appendectomy' requires redefinition based on the presence of subtle pathological changes.
    • Special assays can reveal abnormalities missed by standard histological examination in pediatric appendectomies.
    • Further research is warranted to understand the clinical implications of these redefined 'negative appendectomies'.