Crohn's disease presenting as acute appendicitis: Case series

Crohn's disease (CD) is a chronic, transmural inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract. Its rare involvement of the appendix can mimic acute appendicitis, often leading to misdiagnosis and inappropriate initial management.

We report three patients who presented with right lower quadrant abdominal pain and were initially diagnosed and surgically treated for acute appendicitis. However, all were subsequently found to have ileocecal CD. Each case involved complications such as fistula formation or persistent symptoms, ultimately requiring further surgical intervention and appropriate medical therapy with immunosuppressants and biologics.

These cases highlight the diagnostic challenge posed by CD when it presents with symptoms suggestive of acute appendicitis. A history of chronic or recurrent abdominal symptoms, postoperative complications, or atypical findings should raise suspicion for underlying IBD. Timely and accurate diagnosis is crucial to prevent unnecessary surgeries and reduce morbidity.

Misdiagnosis of Crohn's disease as appendicitis led to complications and delayed care. Crohn's disease should be considered in the differential diagnosis of patients presenting with atypical or recurrent right lower quadrant abdominal pain. Early use of fecal calprotectin and imaging can aid diagnosis and improve outcomes in patients with atypical presentations.