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We aimed to establish if subclinical inflammation was present in histologically normal appendices resected from adults with right iliac fossa pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Immunohistochemistry was performed on formalin\u2010fixed paraffin\u2010embedded appendices for tumour necrosis factor (TNF)\u2010\u03b1, interleukin (IL)\u20106, IL\u20102R and serotonin in four groups: Group I (<jats:italic>n<\/jats:italic>\u2009=\u2009120): uncomplicated appendicitis, Group II (<jats:italic>n<\/jats:italic>\u2009=\u2009118): complicated appendicitis (perforation or gangrene), Group III (<jats:italic>n<\/jats:italic>\u2009=\u2009104): histologically normal appendices resected for right iliac fossa pain and Group IV (<jats:italic>n<\/jats:italic>\u2009=\u2009106) appendices resected at elective colectomy. Expression was quantified using the H\u2010scoring system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median, interquartile range expression of TNF\u2010\u03b1 was increased in Groups I (5.9, 3.1\u20139.8), II (6.8, 3.6\u201312.1) and III (9.8, 6.2\u201315.2) when compared with Group IV (3.0, 1.4\u20134.7, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Epithelial expression of IL\u20106\u00a0in Groups II (44.0, 8.0\u201397.0) and III (71.0, 18.5\u2013130.0) was increased when compared with Group IV (9.5, 1.0\u201360.2, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Expression of mucosal IL\u20102R in Groups I (47.4, 34.8\u201369.0), II (37.8, 25.4\u201360.4) and III (18.4, 10.1\u201334.7) was increased when compared with Group IV (2.8, 1.2\u20135.7, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Serotonin content in Groups I (3.0, 0\u201330.0) and II (0, 0\u20138.5) was decreased when compared with Groups III (49.7, 16.7\u2013107.5) and IV (43.5, 9.5\u2013115.8, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Histologically normal appendices resected from symptomatic patients exhibited increased proinflammatory cytokine expression on immunohistochemistry suggesting the presence of an inflammatory process not detected on conventional microscopy.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-021-06288-w","type":"journal-article","created":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T08:46:51Z","timestamp":1630486011000},"page":"3592-3602","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Immunohistochemical Inflammation in Histologically Normal Appendices in Patients with Right Iliac Fossa Pain"],"prefix":"10.1002","volume":"45","author":[{"given":"Emmanouil","family":"Psaltis","sequence":"first","affiliation":[{"name":"Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abed M.","family":"Zaitoun","sequence":"additional","affiliation":[{"name":"Pathology, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith R.","family":"Neal","sequence":"additional","affiliation":[{"name":"Public Health and Epidemiology, Nottingham Digestive Diseases Centre, National Institute 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