WOFAPS 2025 8th World Congress of Pediatric Surgery

Yavuz Yılmaz ¹, Elif Emel Ayar Erten ², Merve Kıran ³, Düriye Özer Türkay ³

¹ Department of Pediatric Surgery, Health Sciences University Gulhane Medical Faculty
² Ankara Bilkent City Hospital Department of Pediatric Surgery
³ Ankara Bilkent City Hospital Department of Pathology, Ankara

Introduction:

In approximately 15% of cases undergoing surgery for acute appendicitis (AA), normal findings are observed in the histological examination of the appendix. Neurogenic appendicopathy (NA) is clinically indistinguishable from acute appendicitis and is relatively less known. This retrospective study is designed to investigate the frequency of neurogenic appendicopathy in cases operated on during the COVID-19 pandemic, who were PCR-negative for COVID-19 and showed no histological evidence of appendicitis.

Materials and Methods:

COVID-19 seronegative cases, who were operated on with a preliminary diagnosis of acute appendicitis before and during the pandemic, were divided into two groups, each consisting of 20 randomly selected patients with similar age and equal gender distribution. The groups were defined as follows: Group 1: Patients who underwent surgery for acute appendicitis before the pandemic and showed no histological evidence of appendicitis. Group 2: Patients who underwent surgery for acute appendicitis during the pandemic, had no history of COVID-19, were PCR-negative, and showed no histological evidence of appendicitis.

The examination and laboratory findings of both groups were recorded. All appendix sections were stained with hematoxylin-eosin and S-100. The slides were independently analyzed and scored by two different pathologists (Observer 1 and 2) who were blinded to the patients' clinical histories.

Results:

The ages, genders, fevers, vomiting, diarrhea, dysuria findings, white blood cell counts, C-reactive protein levels, appendiceal diameters, and lengths of hospital stay of the 40 cases included in the study were recorded and compared. Statistically significant differences were found between the two groups in terms of fever, diarrhea, dysuria, and elevated white blood cell counts. In histological examination, both Observer 1 and 2's scores for Group 2 showed statistically significant differences in terms of NA.

Conclusion:

Neurogenic appendicopathy (NA) is characterized by a concentration of nerve cells in the appendix. It is clinically indistinguishable from acute appendicitis but can be identified through histopathological examination. During the pandemic, in cases with symptoms of acute appendicitis but no histological evidence, S-100 staining of the samples revealed a concentration of nerve fibers in the region. These findings suggest that even PCR-negative cases may still be affected by the virus during the pandemic or that the virus may have a localized interaction with the gastrointestinal system.