Laparoscopic Appendectomy for Crohn's Disease of the Appendix Presenting as Acute Appendicitis

Zager, Jonathan S.; Gusani, Niraj J.; DeRubertis, Brian G.; Shaw, Jason A.; Kaufman, Jarrod P.; DeNoto, George

doi:10.1089/109264201750539808

Cited by 5 publications

(1 citation statement)

References 7 publications

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“…Since the correction in stating that the appendix is not excluded from developing Crohn's disease, the incidence of granulomatous appendicitis has been reported from 0.1% to 20% (AbdullGaffar, ; Bischoff et al, 2010). In cases of Crohn's disease that warrant bowel resection, those that included the appendix show a 20–50% incidence of inflammatory changes in the appendix consistent with Crohn's disease (Nugent, ; Zager et al, ; Bischoff et al, 2010).…”

Section: Appendicitismentioning

confidence: 99%

The vermiform appendix: A review

Barlow

Muhleman

Gielecki³

et al. 2013

Clinical Anatomy

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New research on the vermiform appendix has shed light on its function. In further understanding the function of the appendix, this information should not negatively impact the clinical judgment in the event of appendicitis. Although the appendix and its pathology have been noted for centuries, it still presents a challenge in the operating room. The most common emergency surgical procedure performed is an appendectomy. Its highly variable position within the abdomen can cause confusion for clinicians. However, improved imaging modalities have heightened the physician's ability to diagnose disease of this organ. This article reviews germane literature regarding the human vermiform appendix.

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Section: Appendicitismentioning

confidence: 99%

The vermiform appendix: A review

Barlow

Muhleman

Gielecki³

et al. 2013

Clinical Anatomy

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Surgical Management of IBD Emergencies: the Approach in a Peripheral Hospital

Thaler¹,

Marsoner²,

Colucci

et al. 2006

Inflammatory Bowel Disease and Familial Adenomatous Polyposis

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Crohn’s disease limited to the appendix: a case report in a pediatric patient

et al. 2010

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In the original description of Crohn's disease, the appendix was not believed to be involved in the inflammatory process. Later on, case reports started to appear in publications demonstrating that the appendix could be involved in the inflammatory changes of Crohn's disease, and it could also be the primary or the sole manifestation of the disease. Being that appendectomies are one of the most common procedures performed by pediatric surgeons, the knowledge about this diagnosis, all be it rare, is important. Our aim was to report a case and discuss the results of our literature review in order to elucidate the probability of a pediatric patient subsequently developing full Crohn's disease and the follow up that is indicated in such patients. A 12-year-old male patient presented with a history of chronic abdominal pain (3-4 times per week) for 1 year, crampy in nature, localized in the left lower quadrant, and associated with diarrhea (2 episodes per day). There were no extraintestinal manifestations of Crohn's, such as arthralgia or uveitis. Important family history included two paternal uncles with ulcerative colitis both of whom currently have stomas. The only abnormal laboratory value in our patient was an elevated fecal calprotectin level. An esophagogastroduodenoscopy and colonoscopy were performed and found to be unremarkable except for the cecum where it appeared that an exudate was emanating from the appendiceal orifice. A magnetic resonance enterography was ordered and showed an enlarged enhancing appendix. An exploratory laparoscopy identified an appendix with macroscopic cobblestone or lymphoid reaction that histologically was consistent with Crohn's disease. It appears that the Crohn's appendix is more indolent than Crohn's disease of the ileum or colon, with a recurrence rate in the largest series of 8%. The interval time from diagnosis to recurrence varied from 1 to 48 months with an average of 19 months. Some authors debate the need of follow up at all in those patients, believing that the appendectomy alone is curative in the majority of patients. Others recommend follow up for up to 5 years.

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Laparoscopic Appendectomy for Crohn's Disease of the Appendix Presenting as Acute Appendicitis

Abstract: Crohn's disease of the appendix can mimic acute appendicitis, although often with a more indolent course. The disease may be treated successfully by laparoscopic appendectomy, with good long-term results.

Cited by 5 publications

References 7 publications

The vermiform appendix: A review

The vermiform appendix: A review

Surgical Management of IBD Emergencies: the Approach in a Peripheral Hospital

Crohn’s disease limited to the appendix: a case report in a pediatric patient

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