Neurogenic appendicopathy: A rare differential diagnosis of acute appendicitis

IF 2 4区 医学 Q2 SURGERY Journal of Visceral Surgery Pub Date : 2024-02-01 DOI:10.1016/j.jviscsurg.2023.02.006
E. Dohner , F. Kierdorf , P. Moreno , R. Langer , M. Zuber , R. Fahrner
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Abstract

Aim of the study

In histologically non-inflamed but clinically suspect appendices, changes described as neurogenic appendicopathy with fibrous or fibrolipomatous obliterations can be observed. The purpose of this study was to analyse the incidence of these entities of the appendix in a longitudinal patient cohort.

Patients and methods

This is a retrospective single-centre study of 457 patients undergoing laparoscopic appendectomy from 2017 to 2020 due to suspected acute appendicitis.

Results

In 72 patients (15.8%) with clinically suspected acute appendicitis, the appendix showed no distinct signs of acute inflammation during the procedure. In 43 patients, histological analysis revealed neurogenic appendicopathy or fibrous and fibrolipomatous obliteration. Female gender (P = 0.088), younger age (P < 0.0001), longer pain duration (P < 0.0001) and repetitive pain episodes were more frequent in these patients than in those with acute appendicitis. Inflammation markers were also decreased in the group of patients with neurogenic appendicopathy (leukocytes 9.8 ± 3.5 vs. 13.0 ± 4.5 G/L and C-reactive protein 38.7 ± 60.7 vs. 59.4 ± 70.5 mg/L).

Conclusion

Neurogenic appendicopathy with fibrous/fibrolipomatous obliteration is a differential diagnosis of acute appendicitis that can only be confirmed by pathology. Female gender, young age, prolonged duration with repetitive episodes of pain, and relatively low inflammatory markers are evocative of this diagnosis.

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神经源性阑尾炎:急性阑尾炎的罕见鉴别诊断。
研究目的在组织学上无炎症但临床上可疑的阑尾中,可观察到带有纤维或纤维脂肪瘤阻塞的神经源性阑尾病变。本研究的目的是在一个纵向患者队列中分析这些阑尾实体的发病率:这是一项回顾性单中心研究,研究对象是2017年至2020年期间因疑似急性阑尾炎而接受腹腔镜阑尾切除术的457名患者:在72名临床疑似急性阑尾炎患者(15.8%)中,阑尾在手术过程中未显示明显的急性炎症迹象。在43名患者中,组织学分析显示出神经源性阑尾炎或纤维和纤维脂肪瘤性阑尾炎。女性(P=0.088)、年轻(PConclusion:神经源性阑尾炎伴纤维性/纤维脂肪瘤性闭塞是急性阑尾炎的一个鉴别诊断,只能通过病理证实。女性性别、年轻、病程长且疼痛反复发作、炎症指标相对较低等特征均提示了这一诊断。
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来源期刊
CiteScore
2.00
自引率
9.50%
发文量
108
审稿时长
>12 weeks
期刊介绍: The Journal of Visceral Surgery (JVS) is the online-only, English version of the French Journal de Chirurgie Viscérale. The journal focuses on clinical research and continuing education, and publishes original and review articles related to general surgery, as well as press reviews of recently published major international works. High-quality illustrations of surgical techniques, images and videos serve as support for clinical evaluation and practice optimization. JVS is indexed in the main international databases (including Medline) and is accessible worldwide through ScienceDirect and ClinicalKey.
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