Neurogenic appendicopathy: a clinical disease entity?
OBJECTIVE
This study compared two histopathological examinations for the diagnosis of neurogenic appendicopathy (NA), assessed the frequency of NA, and evaluated whether it is a clinical disease entity distinct from acute appendicitis.


METHODS
In a prospective observational multicenter study (surgical departments of five hospitals with one reference pathology) we evaluated 282 patients who underwent appendectomy for suspected appendicitis; we examined the frequency of NA in acute appendicitis and in the negative appendectomy group. For the diagnosis two staining methods were compared. We also attempted to determine clinical features of NA.


RESULTS
We observed 93% accuracy for hematoxylin-eosin staining compared with S-100 staining (reference standard) in the diagnosis of NA. There was NA in 3.8% of patients with acute appendicitis and in 47% of those with negative appendectomy. We observed significant differences between the three groups (NA without appendicitis, acute appendicitis, and negative appendectomy without neurogenic appendicopathy) only for sex, age, vomiting, similar previous complaints, rebound tenderness, guarding, rigidity, leukocytes (univariate analysis) and sex (multivariate analysis).


CONCLUSIONS
Neurogenic appendicopathy is a histopathological entity that can be identified by hematoxylin-eosin staining. History and clinical examination do not enable us preoperatively to differentiate between acute appendicitis, NA, and negative appendectomy.
Franke
C
C
Department of General and Trauma Surgery, Heinrich Heine University, Düsseldorf, Germany. Claus.Franke@med.uni-duesseldorf.de
Gerharz
C D
CD
Böhner
H
H
Ohmann
C
C
Heydrich
G
G
Krämling
H J
HJ
Stock
W
W
Rosen
D
D
Kurpreugsch
K
K
Röher
H D
HD
D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D001065:Appendix / Q000294:innervation* / Q000473:pathology; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D004801:Eosine Yellowish-(YS); D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013194:Staining and Labeling; D019564:Unnecessary Procedures
D004801:Eosine Yellowish-(YS)