High Diagnostic Accuracy but Persistent Risk of Complicated Appendicitis: A Retrospective Analysis from Hail Province, Saudi Arabia.

Context: Acute appendicitis is a common surgical emergency. While clinical diagnosis is generally effective, it is not perfect, potentially leading to negative appendectomies or delayed treatment. Aims: This study investigated the histopathological patterns of appendectomy specimens in King Khalid Hospital, Hail Province, Saudi Arabia, correlating them with preoperative clinical diagnoses to assess diagnostic accuracy and guide optimal management. Subjects and Methods: A retrospective analysis was conducted on 198 patients who underwent appendectomies between August 2023 and July 2024. Resected appendix specimens underwent histopathological examination and were categorized as inflamed, malignant, or benign. Clinical data and histopathological findings were compared using statistical analyses, including Fisher's exact test, to assess diagnostic accuracy and explore potential associations between patient demographics, appendicitis severity, and clinical presentation. Results: The study cohort consisted predominantly of young males (78.8%, mean age: 26 ± 9.2 years), with no pediatric cases included. The most common histopathological finding was an inflamed appendix (99.5%), with acute inflammation being most prevalent (86.9%). Perforation (10.1%) and gangrenous changes (2.5%) were also observed. A rare case of negative appendectomy (0.5%) was attributed to a perforated Meckel's diverticulum. Conclusions: This study demonstrates a high preoperative diagnostic accuracy for acute appendicitis. However, the occurrence of negative appendectomies and complicated cases, particularly in young adult males, highlights the need for continuous vigilance and refinement of diagnostic approaches. Further research exploring age- and sex-specific risk factors for complicated appendicitis is crucial to optimizing patient management strategies and minimizing unnecessary surgical interventions.