Report of a Case with Crohn's Disease Presenting as Acute Appendicitis

Tatsuya Kato¹⁾²⁾, Tetsufumi Kojima¹⁾, Tetsuya Shimizu¹⁾, Syuji Kitashiro¹⁾²⁾, Kazuya Konishi¹⁾²⁾, Takumi Yamabuki¹⁾²⁾, Shunichi Okushiba²⁾, Hiroyuki Kato²⁾ and Hidetoshi Sato³⁾

¹⁾Department of Surgery, Hakodate Central General Hospital
²⁾Division of Cancer Medicine, Cancer Medicine, Surgical Oncology,
Hokkaido University Graduate School of Medicine
³⁾Department of Pathology, Sapporo City Hospital

A 23-year-old woman, complaining of right lower abdominal pain and fever, was diagnosed as having typical acute appendicitis, and treated by laparoscopic appendectomy. The pathological diagnosis was acute on chronic appendicitis. However, slight fever, right lower abdominal pain, and elevation of serum CRP persisted postoperatively, and Crohn's disease was diagnosed based on the results of further investigation. Subsequently, because strictures of the ascending and transverse colon had been aggravated and ileac symptom was appeared, right hemicolectomy was performed and histopathological study of the resected specimen showed typical Crohn's disease features. A retrospective review of the appendiceal specimen revealed localized acute inflammation associated with a fissuring ulcer at the base of the appendix, and a non-caseous epithelioid cell granuloma with Langhans' giant cells in its deeper layer. Therefore, the appendicits was ultimately attributed to Crohn's disease. In the differential diagnosis of the causes of acute appendicitis, Crohn's disease should be considered as in this case. Furthermore, investigation of suspected Crohn's disease is important in patients with persistent fever, abdominal pain, and inflammatory reactions after appendectomy.

Key words
Crohn' s disease, acute appendicitis, laparoscopic appendectomy

Reprint requests
Tatsuya Kato Hokkaido University Graduate School of Medicine, Division of Cancer Medicine, Cancer Medicine, Surgical Oncology N15W7, Kita-ku, Sapporo, 060-8638 JAPAN

Accepted
April 26, 2000

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