# Neurogenic Appendicopathy in Pediatric Appendectomies During the COVID‐19 Era: A Retrospective Analysis of Histologically Negative Cases

## TL;DR

This study explores a rare condition called neurogenic appendicopathy in children who had appendectomies during the pandemic but showed no signs of appendicitis.

## Contribution

The study introduces a potential link between neurogenic appendicopathy and the pandemic, even in PCR-negative patients.

## Key findings

- Patients during the pandemic showed significant differences in fever, diarrhea, and white blood cell counts compared to pre-pandemic cases.
- Histological analysis revealed statistically significant differences in neurogenic appendicopathy between the two groups.
- S-100 staining identified nerve fiber concentrations in appendices with no histological evidence of appendicitis.

## Abstract

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 AA and is relatively less known. This retrospective study is designed to investigate the frequency of NA in patients operated on during the COVID‐19 pandemic who were PCR‐negative for COVID‐19 and showed no histological evidence of appendicitis.

Pediatric patients presenting with classic symptoms of AA (right lower quadrant pain, tenderness, and nausea/vomiting) and supporting laboratory/ultrasonographic findings underwent appendectomy based on standard clinical criteria.

COVID‐19 seronegative patients, who were operated on with a preliminary diagnosis of AA 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 AA before the pandemic and showed no histological evidence of appendicitis. Group 2: Patients who underwent surgery for AA 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 (Observers 1 and 2) who were blinded to the patients′ clinical histories.

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 Observers 1 and 2′s scores for Group 2 showed statistically significant differences in terms of NA.

NA is characterized by a concentration of nerve cells in the appendix. It is clinically indistinguishable from AA but can be identified through histopathological examination. During the pandemic, in cases with symptoms of AA 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.