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Crohn's disease presenting as acute appendicitis: Case series
Abate Bane Shewaye1, Kaleb Assefa Berhane2, Samrawit Solomon2
1Adera Medical and Surgical Center, Addis Ababa 1000, Ethiopia; Addis Ababa University, College of Health Sciences, Department of Internal Medicine, Addis Ababa 1000, Ethiopia.
Insights
Crohn's disease (CD) can mimic appendicitis, leading to misdiagnosis and complications. Early diagnosis using fecal calprotectin and imaging is crucial for patients with atypical right lower quadrant pain.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease
- Surgical Pathology
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) affecting the GI tract.
- Appendiceal CD can present as acute appendicitis, causing diagnostic challenges.
Purpose of the Study:
- To highlight the diagnostic difficulties of Crohn's disease presenting as appendicitis.
- To emphasize the importance of considering CD in atypical appendicitis cases.
Main Methods:
- Case series reporting three patients with ileocecal CD initially diagnosed as acute appendicitis.
- Review of clinical presentations, misdiagnosis, complications, and subsequent management.
Main Results:
- All three patients underwent surgery for presumed appendicitis but were later diagnosed with ileocecal CD.
- Complications included fistula formation and persistent symptoms, necessitating further intervention.
Conclusions:
- Misdiagnosing CD as appendicitis leads to delayed treatment and increased morbidity.
- Consider CD in patients with atypical or recurrent right lower quadrant pain.
- Fecal calprotectin and imaging aid early diagnosis and improve outcomes.
Introduction And Importance:
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.
Case Presentation:
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.
Clinical Discussion:
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.
Conclusion:
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.
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