Incidental appendectomy? Microscopy tells another story: A retrospective cohort study in patients presenting acute right lower quadrant abdominal pain

•Only 24% of macroscopically normal appendices during laparoscopy for acute lower abdominal pain are histologically normal.•The majority of normal-looking appendices showed a catarrhal inflammation without serosa involvement at histology.•A 2% of the innocent appendices showed a neuroendocrine tumor leading the patients to receive further treatments.•Appendectomy should be performed in all diagnostic laparoscopies for acute lower abdominal pain showing a normal appendix.

BackgroundOptimal management of macroscopically normal appendix encountered during laparoscopy for acute abdominal pain is still unclear.Methods164 acute abdominal pain cases in which laparoscopy showed a normal appendix were reviewed. No other intra-peritoneal acute disease was present in 50 patients (Group 1) whereas a miscellanea of intra-peritoneal conditions was identified in the other 114 (Group 2). All the patients underwent appendectomy with specimen examination.ResultsFollowing incidental appendectomy significant microscopical changes were seen in 125 specimens (76%). Among these, inflammation was found in 122 and neuroendocrine tumors in 3. Appendices harbored pathological changes in n = 45 patients (90%) of Group 1 and in n = 34 patients (70%) of Group 2 patients (p < 0.05). Morbidity for incidental appendectomy was 2%.ConclusionThis study supports an appendectomy in patients who are undergoing laparoscopy for acute right lower quadrant abdominal pain even when the appendix appears normal on visual inspection.