Department of General, Visceral, Thoracic and Vascular Surgery, University Medicine, Greifswald, Ernst-Moritz-Arndt-University, Ferdinand Sauerbruchstraße 8, 17475 Greifswald, Germany.
Int J Colorectal Dis. 2013 Aug;28(8):1081-9. doi: 10.1007/s00384-013-1677-x. Epub 2013 Mar 21.
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.
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.
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.
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.
“神经源性阑尾病”一词用于因急性阑尾炎而手术的患者，其阑尾缺乏急性炎症迹象。本回顾性研究的目的是阐明潜在的神经源性阑尾病的存在，分析患者的临床症状及其相应的阑尾标本。
确定了 121 例表现为慢性阑尾炎组织学诊断的患者。最终，有 40 例患者符合“神经源性阑尾病”的潜在诊断标准。用免疫组织化学方法检查阑尾标本中 S-100、血管活性肠肽 (VIP) 和 P 物质的表达。对照组包括 110 例急性阑尾炎患者和 120 例因其他原因行阑尾切除术的患者。
最终，120 例患者中有 40 例符合“神经源性阑尾病”的潜在诊断标准。与急性阑尾炎患者相比，临床症状仅有少许差异。组织学上，神经瘤被认为是神经源性阑尾病的特征，在对照组中明显更常见 (p = 0.01)。在阑尾病组中 S-100 的表达明显更高 (p = 0.0024)，但对照组中也有近 50%的标本表现出强烈的染色。在阑尾病标本的黏膜中，S-100(+)神经纤维明显更多 (p = 0.00122)，但只有 25%的标本如此。在对照组中 VIP 的表达更强 (p = 0.0211)。P 物质无诊断价值。
我们的研究无法证实阑尾病的神经源性起源。然而，临床数据强烈提示“阑尾病”实体的存在。因此，如果在腹腔镜检查中找不到其他原因，我们建议对有类似阑尾炎症状的患者切除宏观上正常的阑尾。
