Singapore Med J 2009; 50(12) : 1145 Original Article Minimal Access Unit, Department of General Surgery, Princess Royal University Hospital, Farnborough Common, Orpington, BR6 8ND, Greater London, The United Kingdom Hussain A, FRCS, FICMS, DipGenSurg Senior Fellow Mahmood H, MB, ChB, DS Clinical Fellow Singhal T, MRCS Registrar Balakrishnan S, MRCS Registrar El-Hasani S, FRCSE, FRCS Consultant Correspondence to: Mr Abdulzahra Hussain Tel: (44) 7949 393892 Fax: (44) 1689 864488 Email: azahrahussain@ yahoo.com What is positive appendicitis? A new answer to an old question. Clinical, macroscopical and microscopical findings in 200 consecutive appendectomies Hussain A, Mahmood H, Singhal T, Balakrishnan S, El-Hasani S ABSTRACT Introduction: The correlation between clinical and histopathology findings in appendicitis has been highlighted by many studies. However, the impact of this correlation on the surgical decision to remove a normal-looking appendix is still vague, with no clear definition of positive appendicitis. The aim of this study was to correlate the histological, operative and clinical diagnoses of acute appendicitis (AA). Methods: 200 patients with a preoperative diagnosis of AA underwent laparoscopic appendectomy. A single consultant surgeon performed all the procedures. The clinical, macroscopical and microscopical outcomes were reported and analysed. Follow-up assessment was performed as an outpatient appointment. Results: 112 women and 88 men were included in this study. The mean age was 18.8 (range 8–83) years. Macroscopical appendicitis was confirmed in 139 (69.5 percent) patients, while microscopical appendicitis was reported in 147 (73.5 percent) specimens of the appendix. Ten (7.2 percent) out of 139 patients who were macroscopically positive were found to have a normal appendix on microscopical examination. Different pathologies were found in 21 (10.5 percent) patients, and all underwent appendectomy. Microscopical appendicitis was confirmed in 10 (25 percent) out of 40 patients who had a normal-looking appendix. Conclusion: The correlation of the clinical, microscopical and macroscopical findings in AA is important in order to understand the natural history of appendicitis, and this may help to formulate a sound surgical decision. These findings are supportive of justifying appendectomy for normal-looking appendices, if no other pathology is found. Keywords: acute appendicitis, macroscopical appendicitis, microscopical appendicitis, right lower quadrant pain Singapore Med J 2009; 50(12): 1145-1149 INTRODUCTION Appendectomy is the treatment of choice for acute appendicitis (AA) which has a morbidity of 3.1%. With perforation, the morbidity is varied but can reach up to 47.2%, while the mortality rate is less than 1%. (1) The high morbidity rate is due to a delay in presentation and initiation of active treatment, as well as patient factors. AA is a potential risk for patients due to the life-threatening complications. Therefore, careful assessment at emergency departments is mandatory to avoid preventable complications associated with AA. (2) Observation has improved the ability to distinguish patients with appendicitis from those without, while negative explorations are related to improper assessments based mainly on the indings of the clinical examination rather than on other related signs and symptoms, as well as the inlammatory markers status. (3,4) The correlation between the clinical and histopathology indings in AA has been considered as the main criteria to nominate positive appendicitis. The aim of this study was to evaluate the clinical, macroscopical and microscopical indings and the postoperative course for patients with a clinical diagnosis of AA, and to determine whether these indings should inluence the surgical decision for clinical right iliac fossa pain. METHODS This study included 200 consecutive patients (112 female and 88 male) who were admitted under the care of single consultant surgeon between September 1999 and January 2007. The clinical diagnosis and the timing of the appendectomy had been made by the surgeon who was not blinded to the preoperative imaging studies required in some patients. The inclusion criteria included all patients who were admitted with a diagnosis of AA (including complicated appendicitis) and who