Pathogenesis of acute appendicitis: review
- Gastroenterology & Hepatology: Open Access
Michael D Levin
Based on the analysis of literature and our own studies we propose hypothesis of the pathogenesis of acute appendicitis (AA), which differs from the generally accepted by following provisions. Acute appendicitis develops as a result of immunological reaction and hyperplasia of the lymphoid tissue of the appendix. The frequency of AA correlates with the rapid growth of sex hormones and depends on age, gender and time of year. Only a small percentage of primary hyperplasia causes a complete occlusion of the lumen and destructive AA. Usually it is exposed to regression without causing the typical symptoms but leaving the damaged nervous system and/or sclerotic changes that violate the peristalsis of the appendix. Feces, lingering in appendix eventually harden, increasing in size and often are calcified. In one of the subsequent attacks of lymphoid hyperplasia, the walls of the appendix wrap around over fecalith, causing obstruction of the lumen, the formation of a closed cavity and the known mechanisms of inflammation. The formation of a closed cavity with high pressure leads to reflex strengthening of tone of the digestive tract, which explains the pain in the epigastrium and vomiting in the first hours of the disease. This is accompanied by increased of the anal canal pressure. The inflammatory process in the appendix leads to increased tone especially in segments of the intestine, lying next to it. Which manifests in the form of spasm of the sigmoid colon and/or ileum, as well as the shortening of the dome of the cecum or/and as the concavity of its inner wall. An increase in the tone of the digestive tract is a nonspecific reaction to inflammation.
acute appendicitis, appendix, pathogenesis, children, diagnosis, inflammation, appendectomy