ROUTINE HISTOPATHOLOGICAL EXAMINATION OF TWO COMMON SURGICAL SPECIMENS-APPENDIX AND GALL BLADDER, ITS USEFULNESS AND IMPACT ON PATIENT MANAGEMENT

BACKGROUND Appendicectomy and cholecystectomy specimens removed from patients with suspected acute/chronic appendicitis or cholecystitis often appear normal, but histopathological analysis of these cases may reveal a more ominous underlying pathology and hence a change in further management. However, a routine examination of all specimens is not well accepted owing to the fact that routinely doing a histopathological examination of all specimens is both money and time consuming. So, to address this question, we evaluated histopathological reports of 510 appendicectomy and cholecystectomy specimens at the Gauhati Medical College and Hospital, Guwahati (Assam) over a period of 1 year. MATERIALS AND METHODS Histopathology reports for all appendices and gall bladders removed were analysed at the GMCH between 1st July 2016 and 30th June 2017 and were reviewed by examination of the case notes. The analysis mainly focussed on the confirmation of inflammatory pathology, incidental unexpected findings other than inflammation, whether these unexpected findings were suspected on macroscopic examination at the time of surgery and the effect on patient management and prognosis. RESULTS The histopathology reports showed a variety of abnormal incidental lesions. Of the 250 appendicectomy specimens, 9 (3.6%) revealed abnormal diagnoses other than inflammatory changes. Only 2 of 9 unexpected pathology (22.22%) were suspected on macroscopic examination intraoperatively. Almost same results were seen on analyses of cholecystectomy specimens. Out of the 260 specimens, 11 (4.23%) showed abnormal pathology and 7 (63.63%) were suspected at the time of surgery. CONCLUSION Almost all of the specimens, which showed incidental abnormal findings had an impact on patient's management or outcome and most of them were not suspected on macroscopic examination at the time of surgery. These would have been missed had the specimens not been examined microscopically. The intra-operative diagnosis of the surgeon is therefore unreliable in detecting abnormalities of the appendix and gall bladder. This study supports the sending of all appendicectomy and cholecystectomy specimens for routine histopathological examination.