Neuroendocrine apendicopathy in morphologically normal appendices of patients with diagnosis of acute appendicitis: Diagnostic study

Differences between inflamed and non inflamed appendices diagnosed as acute appendicitis

“…However, all records were precise and correct, as well as the histological study which was revised by only one pathologist with great experience in digestive diseases. This study belongs to a line of research with several previous publications [ 3 , 12 , 14 , 15 , 22 , 23 , 46 , 47 ]. Actually, other investigations are performed to understand the appendix and the appendicopathies.…”

“…In 2020, these authors studied 12 neuroimmune-endocrine mediators in normal appendices of patients without appendiceal complaints, in apparently normal appendices of patients with a clinical presentation of acute appendicitis, and in non inflamed appendices. Morphologically normal appendices removed owing to a clinical diagnosis of appendicitis were associated with increased expression of neuroimmune-endocrine mediators, with emphasis on synaptophysin, enolase, mast cell-related tryptase, and protein gene product 9.5 in the appendiceal wall [ 47 ]. Therefore, clinical, laboratory and imaging findings characteristic of acute appendicitis may be associated not only with inflammatory but also with neuroimmune-endocrine disorders.…”

“…The high diagnostic uncertainty based on clinical and complementary tests prompted this study, which aimed to investigate the parameters used in the diagnosis of acute appendicitis and to verify the existence of differences concerning noninflammatory appendiceal diseases with similar clinical and complementary presentations. Thus, this study, which belong to a line of research, aimed to compare the clinical, laboratory and US findings between inflammatory and noninflammatory appendiceal disorders diagnosed as acute appendicitis [ 3 , 12 , 14 , 15 , 22 , 23 , 46 , 47 ].…”

Relevant aspects of acute appendicitis

“…Migrating pain to the right flank associated with hyporexia, fever, and a painful mass in the right flank is the classic clinical manifestation of acute appendicitis. However, this medical condition, accompanied by leukocytosis (>10,000/mm 3 ), neutrophilia (70-95%), and toxic granulations in the leukocytes, is present in less than 60% of patients with acute appendicitis 2,10 .…”

Does expression of substance-P in normal appendices confirm the neuroimmune appendicitis or disprove the negative appendectomy?

“…Thoraso-somatic sensory nerve fibers respond to inflammation of the parietal peritoneum leading to the classic pain migration to the right iliac fossa (RIF) that covers the basic characteristics of the appendix in its intact status [1]. Previous literatures confirm neural proliferation in the appendix associated with the increased immunologic reaction to the peptide, substance-P (s-P) and to the vasoactive intestinal polypeptide (VIP) in patients with clinical diagnosis of acute appendicitis (AA) without inflammatory reaction [2] and increase of these mediators in the appendix may cause pain on the RIF in the presence of acute appendicitis (AA) [3], meanwhile immunohistochemistry techniques lead to the detection of many neuropeptide in the gut i.e. s-P, VIP and others [4].…”