Prospective Study
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World J Clin Cases. Dec 16, 2014; 2(12): 888-892
Published online Dec 16, 2014. doi: 10.12998/wjcc.v2.i12.888
Appendiceal Crohn’s disease clinically presenting as acute appendicitis
Hulin Han, Hyunsung Kim, Abdul Rehman, Se Min Jang, Seung Sam Paik
Hulin Han, Hyunsung Kim, Abdul Rehman, Se Min Jang, Seung Sam Paik, Department of Pathology, College of Medicine, Hanyang University, Seoul 133-792, South Korea
Author contributions: Kim H and Rehman A contributed to acquisition of data, the literature search and improved manuscript’s English; Jang SM revised the manuscript critically for important intellectual content; Han H and Paik SS designed and wrote this paper.
Correspondence to: Seung Sam Paik, MD, Department of Pathology, College of Medicine, Hanyang University, 222 Wangsimri-ro, Sungdong-ku, Seoul 133-792, South Korea. sspaik@hanyang.ac.kr
Telephone: +82-2-22908252 Fax: +82-2-22967502
Received: July 24, 2014
Revised: August 19, 2014
Accepted: October 28, 2014
Published online: December 16, 2014
Abstract

AIM: To determine the incidence of appendiceal Crohn’s disease (CD) and to summarize the characteristic histologic features of appendiceal CD.

METHODS: We reviewed the pathology files of 2179 appendectomy specimens from January 2007 to May 2013. The computer-assisted retrieval search facility was utilized to collect specimens. We selected those cases that were diagnosed as CD or chronic granulomatous inflammation and defined the final diagnosis according to the histologic findings of CD, including transmural lymphocytic inflammation, non-caseating epithelioid granulomas, thickening of the appendiceal wall secondary to hypertrophy of muscularis mucosa, mucosal ulceration with crypt abscesses, mucosal fissures, and fistula formation.

RESULTS: We found 12 cases (7 male and 5 female patients, with an average age of 29.8 years) of appendiceal CD. The incidence of appendiceal CD was 0.55%. The chief complaints were right lower quadrant pain, abdominal pain, lower abdominal pain, and diarrhea. The duration of symptom varied from 2 d to 5 mo. The histologic review revealed appendiceal wall thickening in 11 cases (92%), transmural inflammation in all cases (100%), lymphoid aggregates in all cases (100%), epithelioid granulomas in all cases (100%), mucosal ulceration in 11 cases (92%), crypt abscesses in 5 cases (42%), perforation in 2 cases (17%), muscular hypertrophy in 1 case (8%), neural hyperplasia in 5 cases (42%), and perpendicular serosal fibrosis in 8 cases (67%).

CONCLUSION: A typical and protracted clinical course, unusual gross features of the appendix and the characteristic histologic features are a clue in the diagnosis of appendiceal CD.

Keywords: Appendix, Appendectomy, Acute appendicitis, Crohn’s disease, Prognosis

Core tip: Appendiceal Crohn’s disease (CD) is relatively rare and is indistinguishable from acute appendicitis. Appendiceal CD shows a favorable clinical outcome with a low recurrence rate. The differential diagnosis includes intestinal tuberculosis, foreign body reaction, diverticulitis of the appendix, sarcoidosis, actinomycosis, and Yersinia infection. Atypical and protracted clinical course, unusual gross features of the appendix and the characteristic histologic features are a clue in the diagnosis of appendiceal CD.