Send appendix for hp

You could do that but if you take the appendix and histopathologically there is no microscopic appendicitis, this increases the rate of negative appendicitis which should be less than 20% as per BAPs guidelines. Incidentally I would also take the appendix but I wondered what colleagues would do in this situation

There are several issues here. Histopathology is 100% accurate for acute appendicitis but not 100% for appendicopathy or appendiceal colic. Functional problems can be present as elsewhere in GI tract. Also, an appendicolith found in normal appendix with typical symptoms is a proof of underlying disease which is negative on histopathology. It is easy to test this clinically. After the operation patients have pain located where the abdominal wall incisions are but not as it was before the operation. Another proof is that patient have reccurrent or chronic RLQ pain and when the 'normal' appendix is removed in 70% of patients the symptoms are gone.

Go and remove the app.. send to hp...

1. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082605/

2. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. https://www.wses.org.uk/wp-content/uploads/2018/07/acute-appendicitis-guidelines.pdf

Above are some guidelines, proposing not to remove looking normal appendix. But biggest discrepancies are in grades 1-2 (normal-inflamed). I use instrumental palpation - (not squeezing) slight pressure on the appendix and its displacement. If appendix returns to its original position, it is inflamed.

Correct diagnosis of AA in kids requires clinical eval and at least US. When in doubt, CT could be performed. All this will give you way above 90% of correct diagnosis. Still "white" at laparoscopy - should be removed anyway with high chance of positive pathology findings.

Non - op management of uncomplicated appendicitis in chidren practices in many surgical department.