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Crohn's Disease Presenting as Granulomatous Appendicitis
Ryota Otsuka1, Koichi Shinoto1, Yasushi Okazaki1
1Department of Surgery, Yokohama Rosai Hospital, Yokohama City, Japan.
Case Reports in Gastroenterology
|October 17, 2019
Summary
Granulomatous appendicitis is rare and can signal underlying conditions like Crohn's disease (CD). This case highlights the importance of thorough investigation for systemic causes when appendicitis presents with granulomatous inflammation.
Area of Science:
- Gastroenterology
- Pathology
Background:
- Granulomatous appendicitis is an uncommon condition.
- It can be associated with infectious or systemic diseases, including Crohn's disease (CD) and sarcoidosis.
Observation:
- A 28-year-old male presented with right lower abdominal pain, initially suspected as acute appendicitis with abscess.
- Imaging revealed a lesion behind the cecum; conservative treatment failed.
- Appendectomy was performed, and histopathology showed noncaseous epithelioid granulomas in the appendix wall.
Findings:
- Specific staining excluded infectious causes (acid-fast bacilli, fungi).
- Post-discharge colonoscopy revealed inflammation from the cecum to the transverse colon.
- Colon biopsy confirmed severe inflammation, cryptitis, Paneth cells, and a granulomatous lesion, leading to a CD diagnosis.
Implications:
- This case underscores the necessity of investigating systemic causes for granulomatous appendicitis.
- Early and accurate diagnosis of underlying conditions like Crohn's disease is crucial for appropriate patient management.
- Prompt diagnosis and treatment, such as mesalazine for CD, can improve patient outcomes.
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