Diagnostic Accuracy in Appendicitis: A Histopathological Study

Abstract

Objective: Although appendicectomy accounts for the highest number of unnecessary surgical procedures, there is little information on the accuracy of the procedure in Kuwait. Therefore, the objective of this study was to determine the accuracy of pre-operative diagnosis of acute appendicitis and the influence of age, gender and surgical personnel on the rate of normal appendicectomy. Materials and Methods: A retrospective histopathological review of specimens involving ‘acute appendicitis’ in the surgical pathology files of the Mubarak Al-Kabeer Hospital, Kuwait in 1982–1986 and 1992–1996 was carried out. The diagnostic accuracy (DA) was defined as the proportion of specimens in which an inflamed appendix was confirmed microscopically and the negative appendicectomy rate (NAR) was the proportion of appendices that were microscopically normal. Results: The DA was 80 and 84% for 1982–1986 and 1992–1996, respectively. There was a marked decline in the number of females in the second period from 42 to 30%. Females, who accounted for 36% of all cases, comprised 61% of normal appendicectomies with the highest NAR in the 20- to 29-year age group (23.7%). The NAR decreased in the second period from 18.4 to 12.4%. Conclusion: The results show that the clinical diagnostic accuracy of appendicitis in Mubarak Al-Kabeer Hospital is consistent with reports from several centres. However, auditing with routine histopathological examination is still necessary to improve clinical evaluation, particularly in females, many of whom are still subjected to the risks of unnecessary laparotomy.

Appendicitis- Histology Specific Incidence Trends In A Semi Urban Population In New Delhi: A Study Of 262 Cases

“…[3][4][5][6] The clinical presentation and the demographic characteristics of acute appendicitis were similar to other reported series. [3][4][5][6] Acute appendicitis is generally considered to be the end result of a primary obstruction of the appendicular lumen which leads to overgrowth of the bacteria. The causes of obstruction include intestinal worms,lymphadenitis and most commonly calcified fecal deposits known as faecoliths which are formed by inspissation of faecal matter around vegetable fibres.…”

“…The negative appendicectomy rate (NAR) in this study was 7.0% which compares favorably with other studies which showed NAR ranging from 14.4% to 18.4%. [3][4][5] These three studies were all retrospective analyses of cases of acute appendicitis, whereas our study also included appendices removed for recurrent right sided pelvic pain which may account for our comparatively low negative appendicectomy rate. However, Marudanayagam et al analyzed 2660 appendicectomies performed over a 7 year period and also found a high NAR of 28.2% and was significantly higher in females.…”

Is routine histopathological examination of appendectomy specimens useful? A systematic review of the literature

“…The search produced 207 potentially relevant publications, of which 29 were considered relevant to the topic based on abstract and title. Three articles [13–15] and four abstracts [16–19] were excluded because their research questions were different, as well as one abstract [20] and two letters being commentaries without new data [21,22]. Nineteen remaining articles and letters (one prospective case series, eighteen retrospective case series) were selected for further data analysis (Figure 1, Table 1).…”