Granulomatous Appendicitis Revisited: Report of a Case

Abstract

Background: Isolated granulomatous appendicitis is uncommon and previously was considered to be a form of localised Crohn’s disease. However more recent series have noted that relapse is rare after appendicectomy and concluded that the condition is a distinct entity unrelated to Crohn’s disease. Following a case of granulomatous appendicitis at St. Vincent’s University Hospital Dublin, the condition was reviewed and the results are detailed herein. Methods: A case of granulomatous appendicitis is presented with discussion of 4 previous cases encountered in our practice and the literature is reviewed. Results: The clinical presentation was sub-acute appendicitis with a mass palpable in the right iliac fossa. At operation an enlarged, inflamed appendix with a broad base was noted and appendicectomy performed. Histopathology showed numerous granulomata on microscopic examination. The yersinia serology tests were negative. Review of computerised histopathology records in the hospital for the last 7 years showed 4 additional cases of granulomatous appendicitis. This is a total of 5 of 1,615 appendicectomies (an incidence of 0.31%). In all cases, the post-operative course was uneventful and the patients have had no further complaints. Conclusion: This small series provides further evidence that granulomatous appendicitis is a distinct clinical entity unrelated to Crohn’s disease and is cured by appendicectomy. It should be suspected when there is a sub-acute onset of appendicitis and an enlarged, broad-based appendix is found at operation.

Role of Sonological and Plain Abdominal Radiography in Evaluation of Acute Abdomen

“…12 Crohn's appendicitis is a self-limited process. 13,14 In our series, out of one case which was diagnostic of pancreatitis. Ultrasonography showed hypoechoic areas with increased sized of the pancreas, and peri pancreatic collection.…”

Granülomatöz apandisitin basit laboratuar testleriyle ilişkisi. Kontrollü gözlemsel çalışma.

“…Infectious causes are responsible for 38% of cases, and constitute Yersinia, Mycobacterium tuberculosis and other microorganisms, e.g., parasites and fungi [12][13][14]. Yersinia infection accounts for up to 25% of GA [13].…”

“…Sometimes it can't be predicted with simple laboratory and diagnostic imaging like ultrasound; however its consequence after surgery may differ from acute appendicitis [3,4]. The confirmatory diagnosis is made by histopathology and is characterized by the presence of non-necrotizing epithelioid granuloma, and mucosal ulcerations [5,6].…”

Granulomatous appendicitis in a 12-year-old boy

“…Granulomas are known to occur in the gastrointestinal tract in association with a number of systemic granulomatous conditions and infections. The higher incidence in developing countries is believed to be because of increased incidence of tuberculosis and schistosomiasis [18].…”