Download PDF
Eur J Pediatr Surg 2009; 19(1): 30-33
DOI: 10.1055/s-2008-1039029
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Interstitial Cells of Cajal in the Vermiform Appendix in Childhood

A. Richter1 , 2 , C. Wit1 , J.-M. Vanderwinden3 , J. Wit1 , W. Barthlen1
  • 1Clinic for Pediatric Surgery, University Hospital Charité Berlin, Berlin, Germany
  • 2Institut für klinische und interventionelle Radiologie, DRK Kliniken Berlin Mitte, Berlin, Germany
  • 3Laboratoire de Neurophysiologie, Université Libre de Bruxelles Faculté de Médecine, Bruxelles, Belgium
Further Information

Publication History

received November 22, 2007

accepted after revision August 28, 2008

Publication Date:
16 February 2009 (online)

    Permissions and Reprints

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
    CrossrefPubMedGoogle Scholar
  • 2 Arnbjornsson E, Bengmark S. Role of obstruction in the pathogenesis of acute appendicitis.  Am J Surg. 1984;  147 390-392
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 4 Burkitt D P. The aetiology of appendicitis.  Br J Surg. 1971;  58 695
    CrossrefPubMedGoogle Scholar
  • 5 Carr N J. The pathology of acute appendicitis.  Ann Diagn Pathol. 2000;  4 46-58
    CrossrefPubMedGoogle Scholar
  • 6 Christensen J. Commentary on the morphological identification of interstitial cells of Cajal in the gut.  J Auton Nerv Syst. 1992;  37 75-88
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 11 Jackson R H, Kennedy J, Gardner P S. et al . Viruses in the aetiology of acute appendicitis.  Lancet. 1966;  2 711-714
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 13 Larner A J. The aetiology of appendicitis.  Br J Hosp Med. 1988;  39 540-542
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 16 Maeda H, Yamagata A, Nishikawa S. et al . Requirement of c-kit for development of intestinal pacemaker system.  Development. 1992;  116 369-375
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 22 Vanderwinden J M, Rumessen J J. Interstitial cells of Cajal in human gut and gastrointestinal disease.  Microsc Res Tech. 1999;  47 344-360
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 24 Wagner J M, McKinney P, Carpenter J L. Does this patient have appendicitis?.  JAMA. 1996;  276 1589-1594
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Dr. André Richter

Clinic for Pediatric Surgery
University Hospital Charité Berlin

Augustenburger Platz 1

13353 Berlin

Germany

Email: dr.andre-richter@web.de

      >