Introduction

Acute appendicitis is the most common general surgical emergency. The lifetime risk for appendicitis is 7%, commonly occurring in adolescent and young adults^[13]. In England, 42,526 patients underwent appendectomies in the year 2004–5, with a mean age of 28 years^[10]. The rate of acute appendicitis varies among countries. In USA and Europe there is a declining rates of acute appendicitis^[13]. In developing countries due to changes in life style there is increasing incidence in most urban centers^[14]. Despite of advances in technology and imaging modalities, there is dilemma in the diagnosis of acute appendicitis, however histopathological examination still remains the gold standard for the confirmation of appendicitis^[15], whether it is acute or chronic.

Acute appendicitis is defined as an inflammation of the inner lining of the appendix vermiformis, which then spreads to other parts of the organ. Various etiologies for this clinic-pathologic condition have been identified, but luminal obstruction is considered the most critical factor, as it triggers the inflammatory process. When lumen obstruction occurs, intraluminal pressure surpasses that in the appendiceal veins, causing venous outflow obstruction. Finally, ischemia develops in the appendiceal wall, which weakens the epithelial integrity and increases the organ's risk of bacterial invasion.

1. The value of routine histopathological examination of appendicectomy specimens Alun E Jones*, Alexander W Phillips, John R Jarvis and Kevin Sargen
2. Short practice of surgery by Bailey &Love
3. Routine pathological analysis of appendicectomy specimens--is it justified? Khan OA¹, Morhan A, Jegatheeswaran S, Jackson E, Pelikan A.Department of Surgery, St. Mary's Hospital, Isle of Wight, UK.

4. Review of the pathological results of 2660 appendicectomy specimens. Marudana-yagam R¹, Williams GT, Rees BI. Department of General Surgery, University Hospital of Wales, Cardiff, UK.
5. Value of routine histopathological examination of appendices in Hong Kong W CHAN, K H FU From the Department of Pathology, University of Hong Kong, Queen Mary Hospital, Hong Kong

6. Composition of the cellular infiltrate in patients with simple and complex appendi-citis. Gorter RR¹, Wassenaar ECE², de Boer OJ³, Bakx R², Roelofs JJTH³ Bunders MJ⁴, van Heurn LWE², Heij HA
7. Routine histopathologic examination of appendectomy specimens: retrospective analysis of 1255 patients.Emre A¹, Akbulut S, Bozdag Z, Yilmaz M, Kanlioz M, Emre R, Sahin N..
8. Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. Yilmaz M¹, Akbulut S, Kutluturk K, Sahin N, Arabaci E, Ara C, Yilmaz S
9. Acute eosinophilicappendicitis and the significance of eosinophil - Edema lesion. Aravindan KP¹, Vijayaraghavan D, Manipadam MT. Department of Pathology, Medical College, Calicut - 673 008, India.
10. Hospital Episode Statistics Department of Health: [http:www.hesonline.nhs.uk/Ease/servlet/Content Server? siteID=1937 & category ID=204].

11. Nemeth L, Reen DJ, O'Briain D, McDermott M, Pui P: Evidence ofan Inflammatory Pathologic Condition in "Normal" Appendices
12. Neuronal hypertrophy and mast cells in histologically negative, clinically diagnosed acute appendicitis: a quantitative immunophenotypical analysis. Amber S, et al. Indian J Gastroenterol. 2010, Department of pathological, Kasturba medical college, mangalore, Karnataka, in
13. Histopathological examination of appendicectomy specimens at a district hospital of Saudi Arabia, Mohammad Ayub Jat, Farhan Khashim Alswailmi, and shehabalanazi, Dr Mohammad A, yub Jat, FCPS. Assistant professor of surgery, college of medicine, Northern Border University, Arar, Saudia Arabia
14. Role of eosinophils in acute appendicitis, Shrestha R et al. JNMA J Nepal Med Asso 2015
15. The utility of nlr ratio as a severity predictor of acute appendicitis, length of hospital stay and postoperative complication  rates, Kelly ME, et al. Dig surg 2015.

Dr M. Malathi, MD

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