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Laparoscopic appendectomy for Crohn's disease of the appendix presenting as acute appendicitis
J S Zager1, N J Gusani, B G Derubertis
1Department of Surgery. North Shore University Hospital, New York University School of Medicine, Manhasset, USA. jzager@excite.com
Insights
Crohn's disease limited to the appendix is rare and can mimic appendicitis. Laparoscopic appendectomy offers a successful treatment option with good long-term outcomes for this condition.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease.
- Appendiceal CD is a rare manifestation, often presenting as acute appendicitis.
- Recurrence of CD after appendectomy is uncommon.
Observation:
- A 32-year-old male presented with abdominal pain suggestive of appendicitis.
- Imaging revealed an appendiceal inflammatory mass.
- Laparoscopic appendectomy was performed for suspected appendicitis.
Findings:
- Frozen-section examination confirmed Crohn's disease of the appendix.
- The patient remained symptom-free two years post-surgery.
- Laparoscopic appendectomy demonstrated efficacy in treating appendiceal CD.
Implications:
- Appendiceal CD requires careful diagnosis to differentiate from acute appendicitis.
- Laparoscopic appendectomy is a viable and effective surgical approach.
- This case highlights successful long-term management of a rare CD presentation.
Background:
Crohn's disease confined to the appendix is rare but has been well described in the literature. It can mimic acute appendicitis clinically. After surgical treatment, recurrences of Crohn's disease are rare. We report the first case of treatment by laparoscopic appendectomy of Crohn's disease confined to the appendix.
Methods:
A healthy 32-year old man presented with a week-long history of vague lower abdominal pain. Diagnostic work-up, which included CT, enteroclysis, and routine blood work, revealed a patent appendiceal lumen with an inflammatory mass in the right lower quadrant.
Results:
Diagnostic laparoscopy revealed an inflamed appendix, and a laparoscopic appendectomy was performed, with frozen-section examination revealing Crohn's disease of the appendix. Two years after surgery, the patient has not had a recurrence of symptoms.
Conclusions:
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.