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Appendicopathy—a clinical and diagnostic dilemma

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The term “neurogenic appendicopathy” has been used for patients operated on for acute appendicitis with their appendices lacking signs of acute inflammation. The aim of this retrospective study was to clarify the presence of potential neurogenic appendicopathies, analyzing patients’ clinical symptoms and their corresponding appendiceal specimens.

Methods

One hundred twenty-one patients were identified showing a histological diagnosis of chronic appendicitis. Eventually, 40 patients qualified for the potential diagnosis “neurogenic appendicopathy.” Appendix specimens were immunohistochemically examined for the expression of S-100, vasoactive intestinal polypeptide (VIP), and substance P. Controls consisted of 110 patients with acute appendicitis and 120 patients following appendectomies operated on for other reasons.

Results

Eventually, 40 of 120 patients qualified for the potential diagnosis “neurogenic appendicopathy.” Compared to patients with acute appendicitis, there was only little difference in clinical symptoms. Histologically, neuromas, thought of being characteristic of neurogenic appendicopathy, were demonstrated significantly more often in the control group (p = 0.01). S-100 was significantly more expressed in the appendicopathy group (p = 0.0024), but nearly 50 % of control specimens showed an intense staining, too. S-100+ neurofibers were significantly (p = 0.00122) more often found in the mucosa of appendicopathy specimens, but this was true for only 25 % of specimens. VIP was more strongly expressed in control specimens (p = 0.0211). Substance P was of no diagnostic value.

Conclusions

Our study could not confirm the neurogenic origin of appendicopathies. Yet, clinical data strongly suggest the existence of the entity “appendicopathy.” Therefore, we suggest removing a macroscopically unaffected appendix in patients with appendicitis-like symptoms if, on laparoscopy, no other cause can be found.

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Authors and Affiliations

  1. Department of General, Visceral, Thoracic and Vascular Surgery, University Medicine, Greifswald, Ernst-Moritz-Arndt-University, Ferdinand Sauerbruchstraße 8, 17475, Greifswald, Germany

    Lars Ivo Partecke, Franziska Schmidt-Wankel, Wolfram Kessler, Claus-Dieter Heidecke & Wolfram von Bernstorff

  2. Department of Pathology, University Medicine Greifswald, Ernst-Moritz-Arndt-University, Greifswald, Germany

    Andrea Thiele & Frank Dombrowski

  3. Institute of Biometrics, Ernst-Moritz-Arndt University, Greifswald, Germany

    Michael Wodny

Authors
  1. Lars Ivo Partecke
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  2. Andrea Thiele
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  3. Franziska Schmidt-Wankel
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  4. Wolfram Kessler
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  5. Michael Wodny
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  6. Frank Dombrowski
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  7. Claus-Dieter Heidecke
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  8. Wolfram von Bernstorff
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Corresponding author

Correspondence to Lars Ivo Partecke.

Additional information

Andrea Thiele and Franziska Schmidt-Wankel contributed equally to this work.

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Partecke, L.I., Thiele, A., Schmidt-Wankel, F. et al. Appendicopathy—a clinical and diagnostic dilemma. Int J Colorectal Dis 28, 1081–1089 (2013). https://doi.org/10.1007/s00384-013-1677-x

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  • DOI: https://doi.org/10.1007/s00384-013-1677-x

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