Negative appendectomy

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.
  • Rate higher with ultrasound (US) than computed tomography (CT) (8% versus 4% in one series).
  • Rate higher in females than males (33% versus 12% in an Indian series assessed with US).
• Used for quality control among general surgeons.

Gross

See normal vermiform appendix.

DDx:

• Fecal-impacted appendix.

Microscopic

See normal vermiform appendix.

Notes:

• Should be submitted in total.

DDx:

• Acute appendicitis.
• Adenovirus appendicitis.
• Appendiceal neuroendocrine tumour.
• Non-appendiceal pathology - see DDx of acute appendicitis.
  • Isolated periappendicitis.
• Crypt cell carcinoma - AKA goblet cell carcinoid.

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 section 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 section 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.

See also

• Normal appendix.
• Vermiform appendix.