Crohn’s disease of the appendix

Abstract

Although appendectomy is often the first surgical procedure in patients with Crohn's disease (CD), only few data exist on appendiceal CD. The aim of this study was to analyze appendices of CD patients undergoing surgery. We analyzed 149 specimens from consecutive patients with CD who underwent primary right ileocolonic or (sub)total colonic resection. The appendix was present in 90 resection specimens. Histologic findings were compared with those of 180 age and sex matched controls. Thirty-six appendices showed histologic signs of CD (40%): A transmural inflammation was found in 24 cases (67%), and a mucosal inflammation in 12 cases (33%). Histologic hallmarks of mucosal involvement were focal or discontinuous inflammation with crypt distortion and a histiocytic and lymphocytic predominant inflammation. Furthermore, epitheloid granulomas and erosions or ulcers with abundant histiocytes at the lesions base were observed. In comparison to controls luminal obliteration was significantly overrepresented in CD whereas acute phlegmonous appendicitis was underrepresented ( P<0.01). Patients with CD of the appendix showed a more widespread colonic involvement than those without ( P<0.01). This study shows that CD of the appendix exhibits specific histologic features that allow a differentiation from non-CD-associated appendicitis. CD-associated appendicitis is a frequent event, probably signifying a more widespread colonic involvement.

Appendiceal Mucinous Cystadenoma is a Neoplastic Complication Of IBD: Case-Control Study of Primary Appendiceal Neoplasms

“…"Ulcerative appendicitis" occurs in 48%-86% of colectomy specimens, either in continuity with pancolonic inflammation or as a skip lesion when the proximal colon is spared, 4,5,7-10 while Crohn's appendicitis occurs in 40%-52% of colectomy specimens, especially those with extensive disease. 5,6,10 Given that disease duration and histological inflammatory activity have each been directly implicated as independent risk factors for the development of colorectal dysplasia and carcinoma in patients with IBD, 2,49,50 it is reasonable to hypothesize that appendiceal inflammation related to IBD should predispose to analogous forms of appendiceal neoplasia.…”

Prior appendectomy and the phenotype and course of Crohn’s disease

“…First, appendicitis may be the first manifestation of Crohn's disease. The appendix is frequently involved by Crohn's disease [17] , granulomatous appendicitis may in some cases reveal Crohn's disease [18,19] , and resection of a Crohn' s disease appendix may be followed by a long period of remission [20,21] . However, most pathological studies concluded that idiopathic granulomatous appendicitis is nosologically distinct from Crohn's disease [22] and that most of these patients do not develop subsequent Crohn's disease.…”

Pathologie der Appendizitis

“…Eine Crohn-assoziierte Appendizitis ist möglicherweise mit einer fortgeschrittenen Kolonbeteiligung bei Morbus Crohn assoziiert [24]. Bei isolierter granulomatöser Entzündung der Appendix wird eher eine primäre granulomatöse Appendizitis als ein isolierter Morbus Crohn der Appendix diskutiert.…”