• Appendix
• Inflammation
• Audit

Sir

Appendicectomy specimens, resected most commonly for clinically suspected acute appendicitis, are among the most frequently accessioned surgical specimens in general histopathology departments. Although a standard sampling protocol is widely employed, comprising perpendicular sections of the tip with transverse sections to include the mid-appendix and resection margin, there is little agreement on whether it is necessary to embed the entire specimen if initial blocks are negative for inflammation. A previous study reported in this Journal showed little added value to examining the remaining tissue in this scenario.1 In the present study, we describe the macroscopic and histologic features in a series of appendicectomy specimens from a busy teaching hospital, and assess the contribution of processing extra material to a diagnosis of appendicitis when initial blocks were negative (‘occult appendicitis’).

A computerised search was performed for all appendicectomy specimens from 2006 to 2010. Cases in which the appendicectomy was performed for any indication other than clinical acute appendicitis (such as suspected tumours) were excluded. Data fields assessed included sex of the patient, length and macroscopic appearance of appendix (normal or abnormal), number of initial blocks and extra blocks taken, final sampling status (sampled or all embedded) and histological diagnoses. Medians were compared in unpaired groups using the Mann–Whitney test, and categorical variables using Fisher's exact test, with statistical significance accepted as p<0.05.

Seven hundred and forty-seven patients had an appendicectomy for clinical acute appendicitis between 2006 and 2010, of whom 376 were women and 371 were men. A total …