Unexpected appendiceal histopathology during upfront diagnostic laparoscopy for right iliac fossa pain: is a normal-looking appendix always innocent?

Abstract

Right iliac fossa pain is a common reason for emergency gastroenterology and surgery referrals and consultations within all levels of medical care, with acute appendicitis being the most frequent differential diagnosis. Under this notion, and taking into account that traditionally appendicitis is considered a clinical diagnosis, despite the increasing adoption of computed tomography as the default emergency assessment essay, many patients will undergo an upfront diagnostic laparoscopy. Intraoperatively though, our anecdotal experience with similar cases suggests that a notable number of patients had a macroscopically normal appendix, without any evidence of concurrent abdomi-nopelvic pathology that could explain their symptoms; on those occasions, and to prevent future diagnostic confusion, and considering the possibility of non-trans-mural inflammatory changes, our institutional practice was to proceed with appendicectomy in all of these cases. Although this approach is based on the logical above-mentioned rationale, one could justify as unnecessary