Neurogenic appendicopathy: A common yet almost unknown condition - Evaluation of 816 appendices and literature review

Background: Neurogenic appendicopathy (NA) represents an almost unknown pat hology which clinically cannot be differentiated from acute appendicitis. T he diagnosis can only be established histologically. Nerve proliferation an d an increased number of endocrine cells are typical for NA. This study cha racterizes the epidemiology, histology, clinical appearance and therapy of NA. We evaluated the incidence of NA in macroscopically normal specimens fr om patients presenting the symptoms of acute appendicitis and in incidental appendectomies. Patients and methods: 816 routine appendix specimens were examined at the Institute of Pathology, Universitity of Basel, for the pres ence of NA. We analyzed the indication for appendectomy, the histological f orm and the age and sex of the patients. Results: 140 appendices (17.1%) sh owed the histological criteria for NA. 25% of incidental appendectomies wer e positive for NA, as opposed to 53% of the macroscopically normal specimen s of patients presenting the symptoms of acute appendicits (P < 0.0001). NA is more frequent in men than in women (19.5% versus 14.5%, P = 0.057). Out of the total of 140 NA, 105 (12.9%) were classified as central, 12 (1.5%) as intramucosal and 5 (0.6%) as submucosal forms of NA. 18 times (2.2%) the histologic subtype of NA was not specified. Conclusions: This study establ ishes that NA is a frequent, often asymptomatic pathology. In more than hal f of the macroscopically normal specimens of patients presenting symptoms o f acute appendicitis NA can be diagnosed, significantly more than in incide ntal appendectomies. Therefore it is imperative to remove and analyze a mac roscopically normal appendix in a patient presenting symptoms of acute appe ndicitis if no other intraabdominal pathology can be found.