Introduction
Acute appendicitis is a common surgical emergency, diagnosed through clinical assessment, imaging, and laboratory tests. However, histopathology remains the gold standard for confirmation and identifying incidental pathologies.
Method
This retrospective study reviewed appendicectomies performed at Warwick Hospital over one year, excluding suspected malignancies prior to operation. The accuracy of preoperative diagnosis was compared to histopathology, and incidental findings were analyzed.
Results
A total of 249 patients (mean age: 35.6 ± 19 years, range: 6–87) were included, with females comprising 50.6%. Histopathology confirmed acute appendicitis in 207 cases (83%), with 71% showing elevated white cell count (WCC), 43% raised Creactive protein (CRP), and 67.6% undergoing imaging, of which 90% indicated appendicitis. Intraoperatively, 12 cases (5.7%) had a normal-looking appendix. Histology revealed a normal appendix in 24 patients (9.6%), of whom 37.5% had raised inflammatory markers, 50% underwent imaging (12.5% indicating inflammation), and 62% appeared inflamed intraoperatively. In cases with inconclusive preoperative findings, 70% underwent imaging, with
83.3% reported as appendicitis. However, histology identified alternative diagnoses, including chronic inflammation (1.6%), perforated diverticulum (1.2%), lymphoid hyperplasia (0.4%), low-grade mucinous neoplasm (0.8%), adenocarcinoma (0.4%), neuroendocrine tumor (0.4%), and focal hyperplastic changes (0.4%).
Conclusion
Preoperative investigations assist in diagnosing acute appendicitis, but histopathology remains essential for confirming the diagnosis and identifying incidental conditions requiring further management for optimal patient care
Authors
Arafa Adam AbdAllah Bakr
Warwick Hospital, Warwick, United Kingdom
Sameh Fahmy
Warwick Hospital, Warwick, United Kingdom