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Background: Appendicitis is one of the most common indications for nonelective abdominal surgery. This is true in both developed and developing countries. The aim of this study was to describe the pattern of presentation and outcome of management in a large hospital in the developing world. Methods: All patients of the general surgery divisions who had appendicectomy for clinical preoperative diagnosis of acute appendicitis between July 2007 and June 2016 were included in the study. Patients who had incidental appendicectomy were excluded from the study. Data were collected retrospectively using a data collection instrument designed for the study. Results: The total number of appendicectomy operations performed within the stipulated period was 1081. Male:female ratio was 1.37:1. The age range was from 12 years to 80 years. The most common symptom and sign remain the right lower quadrant pain and right iliac fossa tenderness, respectively. The duration of symptoms before presentation ranged from 10 h to 96 h. Approximately 20% or a fifth of the patients had ruptured appendix. Tumor associated appendicitis constituted 2.2%. The negative appendicectomy rate was 9.5%. About 47% of the patients were discharged

questions whether there is progression to suppurative appendicitis.7 Many patients are unsure as to whether their appendix has been removed. Murphy et al 2001 reported that of 176 patients who had laparoscopy for right iliac fossa pain 61% were under the misapprehension that their appendix had been removed.9 They suggest that the removal of a normal appendix adds little to the morbidity of laparoscopy and that the appendix should be removed regardless of its appearance at laparoscopy.10 This is supported by studies where incidental appendicectomy has been performed during total abdominal hysterectomy11 and cystectomy.12 However other studies report increased complications following the removal of a normal appendix.13-17 Data on follow-up of patients who have not had their appendix removed suggest that it is safe to leave a normal appendix in place. Van den Broek et al 2000 reported a prospective study of 109 diagnostic laparoscopies for suspected appendicitis where the appendix was left in place if it looked normal. There were 9 readmissions with only one requiring an appendicectomy.18 Van Dalen et al 2003 reported a prospective randomised study of 63 patients with 10 years follow-up. Patients found at laparoscopy to have a normal appearing appendix were randomised to laparoscopy + open appendicectomy or laparoscopy only. No patients in the diagnostic laparoscopy group developed appendicitis subsequently.19 Teh et al 2000 reported that of 41 patients who had laparoscopy alone for a normal appendix 13 continued to have symptoms and 2 eventually had their normal appendix removed.20 In this study we assess the practice of members of ALSGBI and their views on whether guidelines are desirable.

In spite of the long-standing use of the appendage in urological reconstructive surgery, it wasn't until the 80's that became popular. Anatomical and histological normality is the major consideration to allow use of the appendage in autografting. Over a 9-year period, performance of incidental appendicectomies in abdominal major surgery in adult patients was included as a surgical routine practice in our service. This paper describes the pathoanatomical findings of incidentally removed appendages, discussing the relevance of such findings in the incorporation of the appendage to the urinary tract.

A case of congenital obstructed Treitz9s hernia presenting with bilious vomiting in a newborn baby girl has been presented. Internal herniation of contents within a peritoneal sac of the right paramesocolic hernia formed abdominal cocoon which simulated volvulus neonatorum. Plain radiographs and contrast studies were helpful in defining the nature and extent of the lesion. The patient underwent exploratory laparotomy, reduction of small bowel contents from the hernial sac forming an abdominal cocoon, Ladd9s procedure to correct associated midgut malrotation with incidental appendicectomy uneventfully and recovered well.

Postoperative intussusception of the appendiceal stump is a rare complication of appendicectomy. We report an infant who developed an intussusception of the appendiceal stump 2 days following an appendicectomy performed during a right inguinal herniotomy as a day case. The intussusception was diagnosed on ultrasonography and was to be treated laparoscopically, but spontaneous reduction occurred during induction of general anesthesia.

Appendiceal diverticulitis is a rare presentation, often presenting outside of the classical age grouping for appendicitis. We describe a case of appendiceal diverticulitis and issue a cautionary note in the management of patients with atypical features of right lower quadrant pain. In light of its clinical course the finding of a non-inflamed appendiceal diverticulum should prompt one to consider incidental appendicectomy. We also review the literature on appendiceal diverticulitis.

Ignored for years, the appendix is once again being promoted as having useful surgical potential, notably in the management of incontinence. Incidental and prophylactic appendicectomy with their established complications become less easy to justify as the incidence of appendicitis declines. The role of the appendix in reconstructive surgery is reviewed, with particular reference to urinary reconstruction and to the treatment of chronically constipated or faecally incontinent children by use of the antegrade continence enema.

A 52-year-old male weighing 74 kg presented with a twoday history of colicky pain in the supra-umbilical region. He complained of nausea and anorexia. On the day of presentation, his pain migrated to the right iliac fossa and became constant. Examination revealed a pulse of 90 bpm with a temperature of 98.7 F. He was found to be tender in the right iliac fossa with voluntary guarding and rebound. His white cell count was found to be 11.3 per m with a shift in the neutrophils to the left. His MANTREL score was estimated at 9. A mini-Lanz incision approach for appendicectomy was performed. Serosanguineous peritoneal fluid was noted on entering the cavity. The appendix was macroscopically noninflamed. Intraperitoneal ischemia was suspected at this time, and on mobilization of the intraperitoneal contents, a 1080 torsion of a 8 10 cm lip of omentum was noted (Fig. 1). The ischemic segment was excised between ligatures. An incidental appendicectomy was performed. The patient recovered uneventfully.

Diverticulosis of the appendix is rarely reported. Two cases with this condition, including a unique example of appendiceal diverticulosis presenting at herniorrhaphy, are described. The aetiology of the condition and factors involved in incidental appendicectomy are considered.

The Malone anterograde continence enema (ACE) procedure was planned for a 7-year-old girl with a cloacal malformation and who had undergone several operations elsewhere. In addition to her fecal incontinence problems she also had a vesicostomy for a neuropathic bladder and bilateral grade V VUR. Her records showed that she had undergone an incidental appendicectomy 5 years previously and therefore a Monti procedure was planned. On examining the caecum a tubular mass was palpated in the lumen and the caecum was opened. Surprisingly the appendix had been inverted into the lumen for appendicectomy but was still viable. An attempt to de-invert was successful and the appendix was usable for the Malone procedure (Fig. 1). She also underwent a bilateral Cohen antireflux procedure and Kropp bladder-neck reconstruction at the same time as the ACE.

The effect of intraperitoneal drainage and incidental appendicectomy has been studied in 309 patients who had undergone routine cholecystectomy. Patients who did not have drainage fared better than those in which drains were used. There was an increase in postoperative morbidity when the drain was left in position for more than 48 hours. But when the drain was removed during the first 48 hours the results obtained were the same as for cases in whom no drain was used. Incidental appendicectomy while carrying out cholecystectomy did not affect the morbidity or mortality of the operation. It is concluded that in the absence of bile leakage, drains from the hepatorenal space should be removed within 48 hours, and incidental appendicectomy should be carried out when it can be performed with ease and without undue manipulation.

Two cases of carcinoid tumour of the appendix discovered at the time of abdominal hysterectomy are reported. Aspects of the carcinoid syndrome relevant to the gynaecologist are discussed with reference to the value of routine elective appendicectomy during abdominal surgery.

The records of a consecutive series of 224 patients were analysed to discover the effect of incidental appendicectomy on the wound sepsis rate after cholecystectomy. One hundred and five patients had had a cholecystectomy alone and 119 cholecystectomy with incidental appendicectomy. The incidence of wound sepsis in patients not given adequate antibiotic prophylaxis was significantly lower (16-1%) when cholecystectomy alone was carried out than when the appendix was removed as well (41-1%).

Incidental appendicectomy was performed in 83 of 206 patients undergoing laparotomy for abdominal trauma. No organs were injured in 42 per cent of the appendicectomy patients and in 17 per cent of the non-appendicectomy patients, thus making comparison between the groups unreliable. While the incidence of intestinal perforation was 21 per cent in the appendicectomy patients, the rate of wound infection was only 7 per cent. One complication (pelvic abscess) was possibly attributable to incidental appendicectomy. Since males below the age of 50 face a significant risk of future appendicitis and represent the majority of patients with abdominal trauma, it may be advisable to perform incidental appendicectomy with laparotomy for trauma in such patients. Specific indications for incidental appendicectomy during laparotomy for trauma are suggested.