Routine pathological analysis of appendicectomy specimens--is it justified?

Appendicectomy for acute appendicitis is one of the most commonly performed surgical procedures. Our unit policy has been to conduct pathological examination of all resected specimens, however this practice has recently been questioned. We therefore sought to analyse the utility of routine histological examination of appendicectomy specimens. A consecutive series of 236 patients who underwent open appendicectomy for clinically suspected appendicitis was reviewed. Examination of the specimens revealed inflammation or necrosis in 175 (74%) of the cases-however unexpected histological findings were seen in 10 (4.2%) specimens. In five of these cases (2.1%), these findings resulted in a change in medical therapy. We conclude that appendicectomy specimens from patients with clinically suspected appendicitis show diversity in their histological characteristics; and that routine histological examination can yield clinically significant information in a significant minority of patients.