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Discontinuous appendiceal involvement in ulcerative colitis: pathology and clinical correlation
W B Perry1, F G Opelka, D Smith
1Department of Colorectal Surgery, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana, USA.
Summary
Ulcerative colitis can affect the appendix even with a normal cecum, a "skip" lesion. This discontinuous appendiceal involvement, seen in 12.3% of patients, did not alter clinical outcomes.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Pathology
Background:
- Ulcerative colitis (UC) typically presents with continuous mucosal inflammation from the rectum proximally.
- Recent reports suggest appendiceal UC can occur with a histologically normal cecum, a 'skip' lesion.
- The clinical significance of this discontinuous appendiceal involvement in UC remains unclear.
Purpose of the Study:
- To determine the frequency of discontinuous appendiceal involvement in patients undergoing proctocolectomy for UC.
- To assess the clinical significance of appendiceal skip lesions in UC patients.
Main Methods:
- Retrospective analysis of 57 patients who underwent proctocolectomy for UC between January 1990 and September 1995.
- Exclusion criteria included prior appendectomy or appendiceal lumen obliteration.
- Histological examination of the appendix and cecum to identify discontinuous UC involvement.
Main Results:
- Discontinuous appendiceal involvement was identified in 7 out of 57 patients (12.3%).
- These patients had a histologically normal cecum.
- Clinically, patients with appendiceal skip lesions were indistinguishable from those without, regarding age, medications, surgery type, diagnosis interval, complications, functional results, and clinical course.
Conclusions:
- Discontinuous appendiceal involvement occurs in 12.3% of patients undergoing proctocolectomy for ulcerative colitis.
- This finding does not appear to have a significant impact on the clinical presentation or outcomes of UC patients.
- Appendiceal skip lesions in UC patients behave similarly to those without this feature.
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