Crohn's disease isolated to the appendix: truths and fallacies

Area of Science:

• Gastroenterology
• Pathology

Background:

• Crohn's disease is a chronic inflammatory bowel disease.
• Appendiceal involvement is rare but presents diagnostic challenges.

Purpose of the Study:

• To evaluate the long-term outcomes of patients with Crohn's disease initially confined to the appendix.
• To determine if appendiceal Crohn's disease predicts subsequent gastrointestinal involvement.

Main Methods:

• Retrospective review of 25 cases of appendiceal Crohn's disease from eight Israeli hospitals over 15 years.
• Histologic confirmation, physical examination, radiologic studies, and rectosigmoidoscopy for re-evaluation.
• Literature review of similar cases.

Main Results:

• Histologic diagnosis confirmed in 22 of 25 cases.
• No signs or symptoms of Crohn's disease at other gastrointestinal sites were observed during follow-up (mean 6.4 years).
• 93% of cases with initial appendiceal involvement did not show subsequent bowel disease.

Conclusions:

• Crohn's disease limited to the appendix is typically not a predictor of further gastrointestinal involvement.
• Appendiceal Crohn's disease may represent a distinct entity, possibly chronic granulomatous and follicular appendicitis.
• This condition is often nosologically unrelated to Crohn's disease proper in the majority of cases.