Difference between revisions of "Negative appendectomy"
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A '''negative appendectomy''' is an appendectomy done for presumed [[acute appendicitis]] that is | A '''negative appendectomy''' is an appendectomy done for presumed [[acute appendicitis]] that yields an appendix, that on [[pathology]], is within normal limits. | ||
==General== | ==General== | ||
* | *Relatively common. | ||
* | **Rate higher with ultrasound (US) than computed tomography (CT) (8% versus 4% in one series<ref name=pmid26990317>{{Cite journal | last1 = Lee | first1 = J. | last2 = Ko | first2 = Y. | last3 = Ahn | first3 = S. | last4 = Park | first4 = JH. | last5 = Kim | first5 = HJ. | last6 = Hwang | first6 = SS. | last7 = Lee | first7 = KH. | title = Comparison of US and CT on the effect on negative appendectomy and appendiceal perforation in adolescents and adults: A post-hoc analysis using propensity-score methods. | journal = J Clin Ultrasound | volume = | issue = | pages = | month = Mar | year = 2016 | doi = 10.1002/jcu.22351 | PMID = 26990317 }}</ref>). | ||
**Rate higher in females than males (33% versus 12% in an Indian series assessed with US<ref name=pmid27011482>{{Cite journal | last1 = Joshi | first1 = MK. | last2 = Joshi | first2 = R. | last3 = Alam | first3 = SE. | last4 = Agarwal | first4 = S. | last5 = Kumar | first5 = S. | title = Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized? | journal = Indian J Surg | volume = 77 | issue = Suppl 3 | pages = 913-7 | month = Dec | year = 2015 | doi = 10.1007/s12262-014-1063-0 | PMID = 27011482 }}</ref>). | |||
*Used for quality control among general surgeons. | |||
==Gross== | ==Gross== | ||
See ''[[normal vermiform appendix]]''. | See ''[[normal vermiform appendix]]''. | ||
DDx: | |||
*Fecal-impacted appendix.<ref name=pmid17875592>{{Cite journal | last1 = Park | first1 = NH. | last2 = Park | first2 = CS. | last3 = Lee | first3 = EJ. | last4 = Kim | first4 = MS. | last5 = Ryu | first5 = JA. | last6 = Bae | first6 = JM. | last7 = Song | first7 = JS. | title = Ultrasonographic findings identifying the faecal-impacted appendix: differential findings with acute appendicitis. | journal = Br J Radiol | volume = 80 | issue = 959 | pages = 872-7 | month = Nov | year = 2007 | doi = 10.1259/bjr/80553348 | PMID = 17875592 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
| Line 16: | Line 21: | ||
DDx: | DDx: | ||
*[[Acute appendicitis]]. | *[[Acute appendicitis]]. | ||
*[[Interval appendectomy]] - clinical history is essential. | |||
**Often have chronic inflammation and fibrosis. May have active inflammation. | |||
*[[Adenovirus appendicitis]]. | *[[Adenovirus appendicitis]]. | ||
*[[Appendiceal neuroendocrine tumour]]. | *[[Appendiceal neuroendocrine tumour]]. | ||
| Line 21: | Line 28: | ||
**Isolated [[periappendicitis]]. | **Isolated [[periappendicitis]]. | ||
*[[Crypt cell carcinoma]] - [[AKA]] ''goblet cell carcinoid''. | *[[Crypt cell carcinoma]] - [[AKA]] ''goblet cell carcinoid''. | ||
*Appendix with ''[[Enterobius vermicularis]]'' - organisms in the lumen of the appendix. | |||
==Sign out== | ==Sign out== | ||
| Line 56: | Line 64: | ||
====Alternate==== | ====Alternate==== | ||
The | The sections show appendiceal wall without increased numbers of neutrophils. The | ||
appendiceal lumen has cellular debris and inflammatory cells. The mucosa has prominent lymphoid tissue | appendiceal lumen has cellular debris and inflammatory cells. The mucosa has prominent lymphoid tissue | ||
with germinal centre formation. | with germinal centre formation. | ||
| Line 63: | Line 71: | ||
distortion of the crypt architecture. No granulomas are identified. No cryptitis | distortion of the crypt architecture. No granulomas are identified. No cryptitis | ||
is identified. | is identified. | ||
====Suspected fecal impaction==== | |||
The sections show appendiceal wall without increased numbers of neutrophils. The appendiceal lumen has compact fecal material, cellular debris and inflammatory cells. The mucosa has prominent lymphoid tissue with germinal centre formation. | |||
No intraluminal pathologic micro-organisms are seen. There is no serositis. There is no distortion of the crypt architecture. No granulomas are identified. No cryptitis is identified. No mass lesion is present. | |||
==See also== | ==See also== | ||
*[[Normal appendix]]. | *[[Normal appendix]]. | ||
*[[Vermiform appendix]]. | |||
==References== | ==References== | ||
| Line 71: | Line 85: | ||
[[Category:Gastrointestinal pathology]] | [[Category:Gastrointestinal pathology]] | ||
[[Category: | [[Category:Diagnosis]] | ||
Latest revision as of 16:12, 30 November 2023
A negative appendectomy is an appendectomy done for presumed acute appendicitis that yields an appendix, that on pathology, is within normal limits.
General
- Relatively common.
- Used for quality control among general surgeons.
Gross
See normal vermiform appendix.
DDx:
- Fecal-impacted appendix.[3]
Microscopic
See normal vermiform appendix.
Notes:
- Should be submitted in total.
DDx:
- Acute appendicitis.
- Interval appendectomy - clinical history is essential.
- Often have chronic inflammation and fibrosis. May have active inflammation.
- Adenovirus appendicitis.
- Appendiceal neuroendocrine tumour.
- Non-appendiceal pathology - see DDx of acute appendicitis.
- Isolated periappendicitis.
- Crypt cell carcinoma - AKA goblet cell carcinoid.
- Appendix with Enterobius vermicularis - organisms in the lumen of the appendix.
Sign out
Vermiform Appendix, Appendectomy: - Appendix within normal limits. - One benign lymph node. - NEGATIVE for acute appendicitis and NEGATIVE for periappendicitis. Comment: The specimen was submitted in total.
Block letters
VERMIFORM APPENDIX, APPENDECTOMY: - APPENDIX NEGATIVE FOR ACUTE APPENDICITIS AND NEGATIVE FOR ACUTE PERIAPPENDICITIS.
VERMIFORM APPENDIX, APPENDECTOMY: - APPENDIX WITH LYMPHOID HYPERPLASIA AND FOCAL MUCOSAL EROSIONS. - NEGATIVE FOR ACUTE APPENDICITIS. - NEGATIVE FOR ACUTE PERIAPPENDICITIS.
Micro
The sections show appendiceal wall with focal mucosa erosions and several intraluminal neutrophil clusters. Lymphoid hyperplasia is present. Fecal material is present within the lumen of the appendix.
There are no neutrophils within the muscularis propria. There is no serositis. There is no distortion of the crypt architecture. No granulomas are identified. No cryptitis is identified.
Alternate
The sections show appendiceal wall without increased numbers of neutrophils. The appendiceal lumen has cellular debris and inflammatory cells. The mucosa has prominent lymphoid tissue with germinal centre formation.
No intraluminal pathologic micro-organisms are seen. There is no serositis. There is no distortion of the crypt architecture. No granulomas are identified. No cryptitis is identified.
Suspected fecal impaction
The sections show appendiceal wall without increased numbers of neutrophils. The appendiceal lumen has compact fecal material, cellular debris and inflammatory cells. The mucosa has prominent lymphoid tissue with germinal centre formation.
No intraluminal pathologic micro-organisms are seen. There is no serositis. There is no distortion of the crypt architecture. No granulomas are identified. No cryptitis is identified. No mass lesion is present.
See also
References
- ↑ Lee, J.; Ko, Y.; Ahn, S.; Park, JH.; Kim, HJ.; Hwang, SS.; Lee, KH. (Mar 2016). "Comparison of US and CT on the effect on negative appendectomy and appendiceal perforation in adolescents and adults: A post-hoc analysis using propensity-score methods.". J Clin Ultrasound. doi:10.1002/jcu.22351. PMID 26990317.
- ↑ Joshi, MK.; Joshi, R.; Alam, SE.; Agarwal, S.; Kumar, S. (Dec 2015). "Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?". Indian J Surg 77 (Suppl 3): 913-7. doi:10.1007/s12262-014-1063-0. PMID 27011482.
- ↑ Park, NH.; Park, CS.; Lee, EJ.; Kim, MS.; Ryu, JA.; Bae, JM.; Song, JS. (Nov 2007). "Ultrasonographic findings identifying the faecal-impacted appendix: differential findings with acute appendicitis.". Br J Radiol 80 (959): 872-7. doi:10.1259/bjr/80553348. PMID 17875592.