Significance of Histopathology of Appendectomy Specimens: Analysis From a Teaching Hospital of Pakistan

Background Histopathology of a tissue specimen plays a crucial role in formulating the final diagnosis of any disease. It confirms whether the histopathological findings are in correspondence with the clinical diagnosis and thus suggests an optimal management plan. Standard surgical practices guide that every human tissue specimen must undergo postoperative tissue analysis unless indicated otherwise. Objective To determine the significance of histopathology in determining the final diagnosis of appendectomy specimens. Materials and methods This retrospective clinical study conducted in May 2022 included 100 patients operated for appendectomy from January 1, 2021, to December 31, 2021, in the emergency room of the Department of General Surgery, Unit-III, Lahore General Hospital, Lahore. Data were retrieved from patients' records and the picture archiving and communication system (PACS). A Google Forms-based pro forma (Google, Mountain View, CA) was generated to include the demographic details, clinical manifestations, and histopathology reports of the patients. Descriptive analysis was completed using a Microsoft Excel spreadsheet (Microsoft Corporation, Redmond, WA). Results Fifty-two patients were females out of the total 100. The mean age at presentation was 23.02 ± 12.02 years. Of the samples, 54% were not sent for histopathology. Among the remaining ones, 27% of cases were proven to be acute appendicitis. Alvarado score was 7-10 in 50% of patients. Other lesions proven by histopathology were appendiceal phlegmon (4%), perforated appendix (4%), mucocele (1%), carcinoid tumor (1%), tuberculosis (1%), and adenocarcinoma (1%). Conclusions Histopathological analysis is the gold standard for the tissue diagnosis of a disease. The high percentage of the samples not sent for histopathology is alarming since the appendix is not only a site for inflammatory pathologies but for neoplastic lesions as well. This practice depicts that the incidence of non-inflammatory pathologies is being ignored by healthcare professionals and there is a dire need to emphasize the significance of acquiring histopathology reports for the specimens of appendectomy in all circumstances.

Combined Diagnostic Accuracy of Total Leukocyte Count, Neutrophil Count, and Ultrasonography for the Diagnosis of Acute Appendicitis

Acute appendicitis is a common surgical emergency that classically presents with right lower abdominal pain and tenderness on palpation. The diagnosis is often based on clinical examination in order to avoid the complications of surgery delay, yielding a high rate of negative appendectomies. Ultrasonography is a regularly used modality for establishing the diagnosis, whereas abdominal computed tomography (CT) is often used in sonologically equivocal cases. Other parameters include total leukocyte count, granulocytes, C-reactive protein (CRP), leukocyte elastase activity, D-lactate, phospholipase A2, and interleukin-6 (IL-6). We conducted a prospective study to assess the combined accuracy of total leukocyte count, neutrophil count, and ultrasound as an integrated diagnostic tool. The results of these investigations were tabulated and compared to histopathological evidence of acute appendicitis on biopsy (taken as the gold standard) to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Combined sensitivity and specificity were calculated using cross-tabulation, whereas diagnostic accuracy was estimated from the receiver operating curve (ROC) at the optimal cut-off point. The results showed that the absence of inflammatory findings on ultrasound and normal blood parameters (total leukocyte count and neutrophil count) have a high combined diagnostic accuracy and appendicitis may be ruled out.

Treatment outcomes of acute appendicitis and associated factors among admitted patients with a diagnosis of acute abdomen in Debre Markos Referral Hospital, Amhara Region, North West Ethiopia

INTRODUCTION

Appendicitis is an inflammation of the vermiform appendix and is one of the most common causes of an acute abdomen in young adults. If left untreated, it can lead to appendiceal abscess, perforation and peritonitis.

OBJECTIVE

To assess treatment outcomes of acute appendicitis and associated factors among admitted patients with a diagnosis of acute abdomen. Methods and materials: A cross sectional study was employed among 169 patients using a census. Data were collected from patient medical records by using a checklist. Data were entered using Epi-data and analysed by statistical product and service solution. Logistic regression analysis was employed.

RESULTS

Among 303 patients with a diagnosis of acute abdomen, 169 (55.7%) developed acute appendicitis; of whom, 45 (26.6%) developed unfavourable treatment outcomes. Patients who had elevated white blood cell count at the time of presentation (adjusted odds ratio = 4.7; 95% confidence interval (1.95, 11.35)) and intraoperative appendiceal abscess (adjusted odds ratio = 3.8; 95% confidence interval (1.61, 9.07)) were significantly associated with an unfavourable appendicitis treatment outcome. Conclusion and recommendation: Nearly a quarter of the patients developed unfavourable treatment outcomes. Elevated white blood cell count and intraoperative appendiceal abscess were significantly associated with unfavourable appendicitis treatment outcome. Therefore, early detection and treatment of appendiceal abscess is crucial for a better outcome.