The peri-appendiceal red patch in ulcerative colitis: review of the University of Chicago experience

Previous case series have described patients with a limited extent of ulcerative colitis (UC) and an area in the cecum with focal activity surrounding the appendiceal orifice ["peri-appendiceal red patch" (PARP)]. The clinical significance and prognostic implications of this finding are unknown. We used a tertiary care center database to review the clinical characteristics of UC patients with PARP.

Patients with a clinical diagnosis of UC, less than pancolitis, and in whom a PARP was described were identified and clinical characteristics were reviewed at the University of Chicago.

Of the 622 UC patients, 367 did not have pancolitis. Twenty-nine (7.9%) patients had endoscopically described PARP. Of the 29 patients, 23 (79%) were male, eight had a history of smoking, and none had prior appendectomy. Twenty of 30 (67%) exams that obtained biopsies showed that the histologic activity in the PARP paralleled the activity of the distal colitis. Of the patients, 24 of 29 had a median of 8 years follow-up (range 2-16 years), and these patients had a disease duration of median 12 years (range 0.08-22 years). Eleven of 21 patients with endoscopic follow-up had progression of the extent of disease.

We have confirmed the association of peri-appendiceal inflammation in a subset of patients with the otherwise clinical features of UC. The lack of appendectomy, male preponderance, and parallel histologic activity to the distal colitis are important observations that warrant further investigation into the potential relationship of PARP and UC.