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Appendectomy and biopsy despite inflammatory disease of the bowel
Abstract:
For many years surgeons have preached against the removal of the appendix when regional enteritis is present. A high rate of fistulization and abscess formation supposedly follows appendectomy in such circumstances. This was not borne out in a series of cases in which appendectomy was carried out despite regional enteritis, granulomatous colitis and ulcerative colitis. Two fistulae occurred in 23 patients. Neither fistula was from the appendiceal stump. Appendectomy is probably a reasonable procedure when enteritis is present, although judgment should be exercised if there is appendicocecal involvement.
Insights
Surgeons often avoid appendectomy in patients with regional enteritis due to concerns about complications. However, this study found appendectomy to be a reasonable procedure, with low rates of fistula formation even in cases of enteritis.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Historically, surgeons have advised against appendectomy in patients with regional enteritis.
- This caution stems from the perceived high risk of complications like fistulization and abscess formation.
Purpose of the Study:
- To evaluate the safety and outcomes of appendectomy in patients with co-existing inflammatory bowel diseases.
- To challenge the traditional surgical dogma regarding appendectomy in the presence of enteritis.
Main Methods:
- Retrospective case series analysis.
- Review of appendectomy outcomes in patients diagnosed with regional enteritis, granulomatous colitis, and ulcerative colitis.
Main Results:
- Appendectomy was performed on 23 patients with regional enteritis, granulomatous colitis, or ulcerative colitis.
- Only two cases of fistulization were observed, neither originating from the appendiceal stump.
- This indicates a lower complication rate than previously suggested.
Conclusions:
- Appendectomy appears to be a safe and reasonable surgical option for patients with regional enteritis.
- Careful patient selection and surgical judgment are advised, particularly in cases with appendicocecal involvement.