Muralidhar Manga1, Venkata Chalam Pindicura2, Sridhar Pulluri3, Sunil Kumar Keerthi4, Ramadevi5
BACKGROUND
Acute appendicitis remains the most common cause of acute abdomen requiring surgical intervention. Diagnosis of appendicitis is done on clinical grounds. The aetiology and pathogenesis of appendicitis are poorly understood. The cause of pain in the cases with clinical diagnosis of acute appendicitis but intraoperatively normal looking appendix remains controversial.
The present study aims at determining the cause of pain in these cases by combining routine histopathology, IHC to investigate the status of the enteric nervous system in normal and inflamed appendices.
MATERIALS AND METHODS
In the present study, 694 patients who underwent appendicectomy with diagnosis of acute appendicitis were included. In 89 cases, there were no signs of inflammation intraoperatively. These appendix specimens were followed by histopathological examination by H&E staining. 69 out of 89 specimens did not have signs of inflammation in histological examination by H&E staining.
Cases which are diagnosed as acute appendicitis but histologically negative in H&E staining are taken as study cases.
49 acute appendicitis cases- histologically positive acute appendicitis (HPAA) and 20 appendices from right hemicolectomy specimens were taken as controls.
All these specimens were subjected to;
1) Routine Haematoxylin & Eosin staining.
2) Toluidine blue stain for mast cell evaluation.
3) Immunohistochemistry by S-100 stain for evaluating size and number of the ganglia.
OBSERVATION
The mean mast cell count was more in the histologically negative acute appendicitis group when compared to histologically positive acute appendicitis and control group.
The mean size and number of the ganglia were more in the histologically negative acute appendicitis group when compared to histologically positive acute appendicitis and control groups.
CONCLUSION
Neuronal hypertrophy and mast cells may play a role in the pathogenesis of “appendicitis like pain” in patients with intraoperatively and histologically normal appendices.
