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An “eye” in the gut: the appendix as a sentinel sensory organ of the immune intelligence network
Appendicitis is known to be a surgical disease, as it commonly requires removal of the inflamed vermiform appendix, a tubular prominence of the cecum. Appendicitis occurs due to infection of the vermiform appendix, which becomes enlarged and irritated. Doctors consider appendicitis to be a medical emergency and they usually recommend surgery regardless of the actual stage of the disease. Although the surgical treatment for appendicitis is known to be safe and reliable, many patients develop post-operative complications as a consequence of malpractice. There are also various reported cases of unnecessary appendectomy, performed on patients who eventually turn out to have a healthy
While the surgical intervention for appendicitis involves few risks in the early stages of the disease, advanced infection of the vermiform appendix greatly increases the risks of post-operative complications. The removal of a seriously diseased appendix is difficult and risky, as the operated patients can develop sepsis or abscess soon after the surgical intervention. Well aware of this fact, most physicians focus on timely revealing possible symptoms of appendicitis in patients. Guided by the impulse of intervening promptly, some doctors often mistakenly perform surgery on healthy patients. There were various cases of unnecessary appendicitis surgery reported in the last decades and the phenomenon can also be seen in present.
The cases of unnecessary appendicitis surgery can be easily explained by the deceiving nature of this very common disease. Appendicitis often generates unspecific symptoms which can be misleading in the process of deciding upon the correct diagnosis. Appendicitis is commonly mistaken for various other internal disorders that generate resembling symptoms. To further complicate the matter, sometimes patients with appendicitis may actually be asymptomatic. In such cases, the specific manifestations of appendicitis emerge late after the disease becomes serious.
Although doctors can choose among various medical techniques in order to confirm their presumptive diagnosis, none of the tests available nowadays is 100 percent reliable in revealing clear physiological signs of appendicitis. Considering this fact, surgeons incline towards assuming the risk of removing a healthy appendix rather than allowing the disease to progress further. Delayed medical intervention can be fatal for appendicitis sufferers and this is the main reason why surgeons often choose to timely perform appendectomy on patients who present possible clinical symptoms of the disease.
The overall number of cases of unnecessary appendectomy has known a slight decline in recent years. However, statistics indicate that in present more than 9 percent of pediatric appendectomies are performed on patients who actually have a healthy appendix. This is due to the fact that very young children and infants are more difficult to correctly diagnose with appendicitis. By contrast, the cases of unnecessary appendectomy among adult patients are nowadays more rare.
In present, malpractice and misdiagnosis of appendicitis can be considered to be indicators for the lack of precision of the existent medical techniques. Therefore, modern medicine needs new, more reliable means of diagnosing internal disorders such as appendicitis.
Kimberly A. Bazar,, Patrick Y. Leeb and A. Joon Yun
a Department of Dermatology, San Mateo Medical Center, 222 West 39th Avenue, San Mateo, CA 94403, USA
b Stanford University, Palo Alto, CA, USA
Neural systems are the traditional model of intelligence. Their complex interconnected network of wired neurons acquires, processes, and responds to environmental cues. We propose that the immune system is a parallel system of intelligence in which the gut, including the appendix, plays a prominent role in data acquisition. The immune system is essentially a virtual unwired network of interacting cells that acquires, processes, and responds to environmental data. The data is typically acquired by antigen-presenting cells (APCs) that gather antigenic information from the environment. The APCs chemically digest large antigens and deconstruct them into smaller data packets for sampling by other cells. The gut performs the same function on a larger scale. Morsels of environmental content that enter the gut are sequentially deconstructed by physical and chemical digestion. In addition to providing nutrients, the componentized contents offer environmental data to APCs in mucosa-associated lymphoid tissues (MALT) that relay the sampled information to the immune intelligence network. In this framework, positioning of the appendix immediately after the ileocecal valve is strategic: it is ideally positioned to sample environmental data in its maximally deconstructed state after small bowel digestion. For single-celled organisms, digestion of the environment has been the primary way to sample the surroundings. Prior to the emergence of complex sensory systems such as the eye, even multi-cellular organisms may have relied heavily on digestion to acquire environmental information. While the relative value of immune intelligence has diminished since the emergence of neural intelligence, organisms still use information from both systems in integrated fashion to respond appropriately to ecologic opportunities and challenges. Appendicitis may represent a momentary maladaptation in the evolutionary transition of sensory leadership from the gut to the eye. Relationships between immune dysfunctions and cognition are explored.