Abstract
Background and Aims: The interstitial cells of Cajal (ICC) have not yet been investigated in the vermiform
appendix. They are important for the peristalsis of the gastrointestinal tract and
have been found to be altered in various motility disorders. Motor disturbance has
been suggested as a possible contributor in the unclear etiology of appendicitis.
We wanted to examine the distribution of the ICC in the vermiform appendix. Furthermore
we investigated whether ICC are altered in persons with appendicitis. Methods: We investigated the ICC distribution in 28 appendices of children using immunohistochemistry
and anti-c-kit antibodies. Cells and processes were quantified in normal, acute and
chronic inflamed appendices. Results: IC(C)-CM and IC(C)-LM were found in the circular and longitudinal muscle layers,
respectively. IC(C)-LM, however, were scarce and inhomogeneous in contrast to the
IC(C)-CM. The functionally important subgroups of the colon, the IC(C)-SM and IC(C)-MP,
however, could not be detected in the appendix with the used antibody. There was no
difference in the distribution of detected ICC between normal and inflamed appendices.
Conclusion: IC(C)-LM are altered and IC(C)-SM and IC(C)-MP are lost in the vermiform appendix
with no differences between healthy and inflamed tissue and without a correlation
to appendicitis. Thus, other factors must be considered in the etiology of appendicitis.
Key words
interstitial cells of Cajal (ICC) - appendicitis - innervation
References
- 1
Addiss D G, Shaffner N, Fowler B S. et al .
The epidemiology of appendicitis and appendectomy in the United States.
Am J Epidemiol.
1990;
132
910
- 2
Arnbjornsson E, Bengmark S.
Role of obstruction in the pathogenesis of acute appendicitis.
Am J Surg.
1984;
147
390-392
- 3 Brunner E, Domhof S, Langer F eds. Nonparametric analysis of longitudinal data in
factorial experiments. Expanded and translated edition. New York; Wiley Series in
Probability and Statistics 2002
- 4
Burkitt D P.
The aetiology of appendicitis.
Br J Surg.
1971;
58
695
- 5
Carr N J.
The pathology of acute appendicitis.
Ann Diagn Pathol.
2000;
4
46-58
- 6
Christensen J.
Commentary on the morphological identification of interstitial cells of Cajal in the
gut.
J Auton Nerv Syst.
1992;
37
75-88
- 7
Dueholm S, Bagi P, Bud M.
Laboratory aid in the diagnosis of acute appendicitis. A blinded, prospective trial
concerning diagnostic value of leukocyte count, neutrophil differential count, and
C-reactive protein.
Dis Col Rectum.
1989;
32
855-859
- 8
Ekblad E, Arnbjörnsson E, Ekman R. et al .
Neuropeptides in the human appendix. Distribution and motor effects.
Dig Dis Sci.
1989;
34
1217-1230
- 9
Gauderer M W, Crane M M, Green J A. et al .
Acute appendicitis in children: importance of family history.
J Pediatr Surg.
2001;
36
1214-1217
- 10
Gurleyk E, Gurleyk G, Unalmiser S.
Accuacy of serum C-reactive protein measurements in diagnosis of acute appendicitis
compared with surgeon's clinical impression.
Dis Col Rectum.
1995;
38
1270-1274
- 11
Jackson R H, Kennedy J, Gardner P S. et al .
Viruses in the aetiology of acute appendicitis.
Lancet.
1966;
2
711-714
- 12
King S K, Sutcliffe J R, Hutson J M. et al .
Paediatric constipation for adult surgeons – 2: new microscopic abnormalities and
therapies.
ANZ J Surg.
2004;
74
890-894
- 13
Larner A J.
The aetiology of appendicitis.
Br J Hosp Med.
1988;
39
540-542
- 14
Lee J I, Park H, Kamm M A, Talbot I C.
Decreased density of interstitial cells of Cajal and neuronal cells in patients with
slow-transit constipation and acquired megacolon.
J Gastroenterol Hepatol.
2005;
20
1292-1298
- 15
Lyford G L, He C L, Soffer E. et al .
Pan-colonic decrease in interstitial cells of Cajal in patients with slow transit
constipation.
Gut.
2002;
51
496-501
- 16
Maeda H, Yamagata A, Nishikawa S. et al .
Requirement of c-kit for development of intestinal pacemaker system.
Development.
1992;
116
369-375
- 17
Miller S M, Narasimhan R A, Schmalz P F. et al .
Distribution of interstitial cells of Cajal and nitrergic neurons in normal and diabetic
human appendix.
Neurogastroenterol Motil.
2008;
20
349-357
- 18
Roumen R M, Groenendijk R P, Sloots C E. et al .
Randomized clinical trial evaluating elective laparoscopic appendicectomy for chronic
right lower-quadrant pain.
Br J Surg.
2008;
95
169-174
- 19
Rumessen J J, Vanderwinden J M.
Interstitial cells in the musculature of the gastrointestinal tract: Cajal and beyond.
Int Rev Cytol.
2003;
229
115-208
- 20
Sanders K M, Ördog T, Koh S D. et al .
A novel pacemaker mechanism drives gastrointestinal rhythmicity.
News Physiol Sci.
2000;
15
291-298
- 21
Sanders K M, Ördög T, Koh S D. et al .
Development and plasticity of interstitial cells of Cajal.
Neurogastroenterol Motil.
1999;
11
311-338
- 22
Vanderwinden J M, Rumessen J J.
Interstitial cells of Cajal in human gut and gastrointestinal disease.
Microsc Res Tech.
1999;
47
344-360
- 23
Vanderwinden J M, Rumessen J J, Liu H.
Interstitial cells of Cajal in human colon and in Hirschsprung's disease.
Gastroenterology.
1996;
111
901-910
- 24
Wagner J M, McKinney P, Carpenter J L.
Does this patient have appendicitis?.
JAMA.
1996;
276
1589-1594
- 25
Wedel T, Spiegler J, Soellner S. et al .
Enteric nerves and interstitial cells of Cajal are altered in patients with slow-transit
constipation and megacolon.
Gastroenterology.
2002;
123
1459-1467
Dr. André Richter
Clinic for Pediatric Surgery
University Hospital Charité Berlin
Augustenburger Platz 1
13353 Berlin
Germany
Email: dr.andre-richter@web.de