Isolated Crohn’s disease of the vermiform appendix or chronic granulomatous appendicis?

Abstract

SUMMARY
The etiology of granulomatous appendicitis includes infectious
diseases, foreign bodies and diseases of unknown etiology
such as Crohns disease and sarcoidosis. Pain in the
right lower guardant is a common symptom of intestinal
Crohns disease but, pain in this area can also be the presenting
symptom of acute appendicitis. Crohns disease
affects any part of the gastrointestinal tract including the
vermiform appendix. Crohns disease initially confined to
the appendix is rare and there are less than 100 well-documented
cases in the literature. A 28-years-old female patient
was admitted to our hospital because of fever up to
39oC and abdominal pain in the right lower quadrant with
bloating. Serology and faecal, urine and blood cultures for
microbial infection including Yersinia proved negaive. Lower
abdomen ultrasonography revealed no evidence of adnexae
inflammation but suspected thickness of the bowel wall
in the right lower quadrant. Because of no response to conservative
treatment two months later surgery was performed.
At laparotomy a long, thickened and distended
appendix was found and removed. No other lesions were
noted in the intestines or mesentery. Histological examination
of the removed appendix showed signs compatible
with Crohns disease of the appendix. In case of Crohns
disease of the appendix two clinical possibilities may arise;
the first is the presence of mild Crohns disease in other
intestinal parts and the second possibility is the risk of relapse
which occurred in 7-14% of the published cases. Could this case be regarded as an isolated Crohns disease of the
appendix or as a granulomatous and follicular appendicitis
of unknown etiology (idiopathic) and unrelated to a formal
Crohns disease according to the accepted definition.
Key words: Crohns disease, appendix, granuloma, appendicitis