Scientific paper
Crohn’s disease limited to the appendix

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Abstract

Background: Crohn’s disease confined to the vermiform appendix is rare. In our study, the incidence was 0.2% of all patients diagnosed with Crohn’s disease at La Paz University Hospital, Madrid, Spain, in 20 years.

Methods: Here we review the clinical records of 10 patients with isolated appendiceal Crohn’s disease.

Results: Preoperative diagnosis was acute appendicitis in all 10 cases, and all patients underwent appendectomy. Postoperative complications were limited to an enterocutaneous fistula in 1 patient. There was no evidence of recurrence during a mean follow-up period of 14.5 years (range 2 to 25 year).

Conclusions: We conclude that Crohn’s disease when confined to the appendix is less aggressive than in other sections of the intestine, with a low recurrence rate and incidence of postoperative fistula.

Section snippets

Material and methods

Here we review the clinical records of all patients diagnosed of Crohn’s disease of the appendix at La Paz University Hospital, Madrid, Spain, between January 1, 1975, and January 1, 1995, excluding patients with simultaneous intestinal and appendiceal symptoms. Patient with positive cultures for Yersinia SP were excluded from the study. These cultures were carried out for all patients. However, serologic tests were not performed because this procedure was not available at our medical center

Results

Ten (0.2%) patients were diagnosed of CD confined to the appendix (6 male and 4 female patients, with an average age of 29 years [range 10 to 33]). The duration of symptoms varied from 1 day to 4 months. All 10 patients complained of pain in the right iliac fossa, 7 patients had nausea and vomiting, 3 were anorexic, and 3 had fever. One patient reported diarrhea 10 days before surgery suggestive of rectal bleeding, although 1 patient had had episodes of diarrhea before hospitalization. Two

Comments

Chronic transmural inflammation with epithelioid granuloma formation in the intestinal wall is characteristic of CD, a condition that can affect the entire length of the gastrointestinal tract [4], [5], [6]. CD confined to the appendix has been reported to occur in 12% to 16% of CD patients undergoing intestinal resection [7] and in 50% of patients with colonic CD [8]. Of the 4,468 appendectomies performed during the period of our study (ie, 20 years), only 0.2% of patients had CD confined to

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