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Appendicopathy--a clinical and diagnostic dilemma
Lars Ivo Partecke1, Andrea Thiele, Franziska Schmidt-Wankel
1Department of General, Visceral, Thoracic and Vascular Surgery, University Medicine, Greifswald, Ernst-Moritz-Arndt-University, Ferdinand Sauerbruchstraße 8, 17475 Greifswald, Germany. partecke@uni-greifswald.de
International Journal of Colorectal Disease
|March 22, 2013
Summary
This study investigated neurogenic appendicopathy, finding no definitive neurogenic origin. However, clinical symptoms suggest appendicopathy exists, recommending appendix removal when no other cause is found.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Neuroscience
Background:
- Neurogenic appendicopathy is a debated entity in patients with appendicitis-like symptoms but without acute inflammation.
- Clinical presentation often mimics acute appendicitis, leading to surgical intervention.
Purpose of the Study:
- To investigate the presence of neurogenic appendicopathy by analyzing clinical symptoms and appendiceal specimens.
- To evaluate immunohistochemical markers (S-100, VIP, Substance P) in suspected cases.
Main Methods:
- Retrospective analysis of 121 patients with chronic appendicitis, identifying 40 potential neurogenic appendicopathy cases.
- Immunohistochemical examination of appendix specimens for S-100, vasoactive intestinal polypeptide (VIP), and Substance P.
- Comparison with control groups: 110 acute appendicitis and 120 other appendectomies.
Main Results:
- Neuromas, considered characteristic, were found more often in controls (p=0.01).
- S-100 expression was higher in appendicopathy cases (p=0.0024), but also frequent in controls.
- VIP was more expressed in controls (p=0.0211); Substance P showed no diagnostic value.
Conclusions:
- The study did not confirm a neurogenic origin for appendicopathy.
- Clinical evidence supports the existence of 'appendicopathy' as a distinct entity.
- Recommendation: Consider removing macroscopically normal appendices in patients with appendicitis-like symptoms if no other cause is identified laparoscopically.
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