The aim of this study was to assess whether a routine HPE of appendectomy specimens is needed and whether routine HPE has an impact on further management of patients. Furthermore, HPE of appendectomy specimens may detect other unusual findings such as parasitic infections, endometriosis or granulomatosis ( 4). However, a policy of selective HPE may miss significant pathology, which may have an impact on patient management. There has been a debate in the literature concerning the routine or selective HPE of appendectomy specimens ( 3). Thus, histopathological examination (HPE) is still considered the most accurate method for confirming appendicitis diagnosis. In addition, many conditions mimic acute appendicitis in their presentation especially in women, causing diagnostic difficulties and increasing the rate of negative appendectomies ( 3). Diagnosis of acute appendicitis is a major challenge, even for experienced surgeons since typical presentations only appear in about 60% of the patients ( 2). The overall lifetime risk of acute appendicitis is about 7.0%, with 8.6% for males and 6.7% for females ( 1). Keywords: Appendectomy, appendicitis, histopathological examination IntroductionĪcute appendicitis is the most common abdominal emergencies encountered in general surgical services. Hence, all appendectomy specimens must be submitted for routine HPE. A number of patients with unusual histopathological findings require anti-helmentic treatment, colectomy, gastroenterology follow-up or periodic surveillance. There were 256 (6.4%) patients who demonstrated unusual findings in their HPE, which included chronic appendicitis (n= 207 5.2%) patients, Enterobius vermicularis (n= 14), Schistosoma (n= 8), Crohn’s disease (n= 1), neuroma (n= 10), carcinoid tumour (n= 5) and mucinous cystadenoma (n= 5), mucocele (n= 4) and mucinous cystadenocarcinoma (n= 2).Ĭonclusion: HPE of the appendix does not only confirm the diagnosis of acute appendicitis, but also detects other unusual diagnoses that may have an impact on a patient’s management. Negative appendectomy rate was 5.6% and was significantly higher in female patients (p< 0.001). Perforation rate was 5.8% and was significantly higher in male patients (p 30 years age group (p= 0.024). Results: Out of the 4012 cases, 3530 (88%) patients showed findings consistent with acute appendicitis on HPE. Material and Methods: From January 2009 to June 2017, all histopathology reports of 4012 consecutive appendectomy specimens for a clinical suspicion of acute appendicitis were retrospectively analyzed in two university hospitals. However, the need for routine histopathological examination (HPE) of all appendectomy specimens has recently been questioned. Objective: For a suspected diagnosis of acute appendicitis, appendectomy is one of the most common emergency abdominal operations performed. Luke’s Hospital, Kilkenny, IrelandĢDepartment of General Surgery, Benghazi Medical Center, Benghazi University, Benghazi, LibyaģDepartment of General Surgery, Al-jala Hospital, Benghazi University, Benghazi, Libya Abstract Osama Elfaedy 1, Mohamed Benkhadoura 2, Akrem Elshaikhy 3, Khaled Elgazwi 3ġDepartment of General Surgery, St. Impact of routine histopathological examination of appendectomy specimens on patient management: a study of 4012 appendectomy specimens
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