Negative appendectomy

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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[1]).
    • Rate higher in females than males (33% versus 12% in an Indian series assessed with US[2]).
  • Used for quality control among general surgeons.

Gross

See normal vermiform appendix.

DDx:

  • Fecal-impacted appendix.[3]

Microscopic

See normal vermiform appendix.

Notes:

DDx:

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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

  1. 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.
  2. 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.
  3. 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.