Review Article: Granulomatous Diseases and Granulomas of the Appendix

Abstract

Granulomatous appendicitis is a rare phenomenon. Idiopathic (primary) granulomatous appendicitis is very rare. It is a diagnosis by exclusion. There are many etiologies, both infectious and noninfectious, for secondary granulomatous appendicitis. Isolated appendiceal Crohn's disease (CD) is no longer an accepted explanation of idiopathic granulomatous appendicitis, but rather, it is thought to be part of more generalized gastrointestinal CD. Yersinia infection and CD constitute the main etiology of granulomatous appendicitis in the West. Infectious causes, mainly tuberculosis and parasitic infestations, are the main culprits in tropical and subtropical countries. This variation is probably a result of differences in the geographical distribution of these diseases. Recently, interval appendectomy has been suggested as an important cause of granulomatous appendicitis. The importance of interval appendectomy may vary according to the local practice of this procedure in each region. Other unusual causes may include sarcoidosis and foreign body reaction, mainly as a result of vegetable matter from feces. A review study of 3381 appendectomy specimens over a 4-year period showed only 13 cases (0.38%) of granulomatous appendicitis. Infectious and noninfectious causes were responsible for 62% and 38% of granulomatous appendicitis, respectively. Parasites alone were responsible for 38.5% of the cases. Interval appendectomy and CD each contributed 15% and 8%, respectively, of the total etiology. Granulomatous appendicitis was more common in young adult males.

Ileocecal ulceration and granulomatous ileitis as an unusual presentation of typhoid fever

“…7 Although intestinal granulomas are rarely seen in typhoid fever, extraintestinal granulomatous changes have been documented (Ap pendix 1, available at www .cmaj .ca /lookup /suppl /doi :10.1503/cmaj.120714/-/DC1). Re ports of granulomas in the liver, bone marrow and spleen with typhoid fever have been published previously.…”

Granülomatöz apandisitin basit laboratuar testleriyle ilişkisi. Kontrollü gözlemsel çalışma.

“…Treatment of GA is usually simple appendectomy, however some challenges may be shown in inflammatory bowel diseases, i.e. fistula in Crohn's disease [10]. In our study we performed ultrasound examination in all patients, however all examinations suspected only acute appendicitis.…”

An unusual case of appendicitis

“…A four-year review of 3381 appendectomy specimens showed only 13 cases (0.38%) of granulomatous appendicitis; of those, only one was believed to have been caused by TB. 9 Other infectious causes for a granulomatous appendix include infection with Yersinia enterocolitica and parasitic infections (such as strongyloidiasis and enterobiasis), whereas noninfectious causes include Crohn disease, sarcoidosis, diverticulitis and foreign body. 9 The treatment for appendicular TB is both surgical and medical.…”

“…9 Other infectious causes for a granulomatous appendix include infection with Yersinia enterocolitica and parasitic infections (such as strongyloidiasis and enterobiasis), whereas noninfectious causes include Crohn disease, sarcoidosis, diverticulitis and foreign body. 9 The treatment for appendicular TB is both surgical and medical. In conjunction with appendectomy, these patients must be given multiple antituberculous antibiotics as per standard guidelines.…”