A Case of Crohn's Disease of the Appendix

Yasuyuki Nonaka, Hiromu Tsuge^* and Masahito Yumura

Department of Surgery, Kobe Red Cross Hospital ^*Department of Surgery, Okayama Municipal Hospital Seno

Crohn's disease of the appendix is rare, with only 14 cases reported in Japan, to our knowledge. A 42-year-old man was admitted due to severe pain with tenderness in the right lower quadrant, muscle guarding, and rebound tenderness. Emergency laparotomy was conducted under a diagnosis of acute appendicitis with peritonitis. During the procedure, the appendix was found to be inflamed, markedly enlarged, and densely adherent to the retroperitoneum, wrapped in omentum. No other lesions were noted in the cecum or terminal ileum. After appendectomy, the resected specimen showed a granular lesion in the mucosa. The walls of the appendix were markedly thickened. Histologically, noncaseating granulomas and lymphoid aggregation were observed with transmural inflammation indicative of Crohn's disease. Postoperative colonoscopic examination revealed a polypoid lesion in the cecal mucosa near the orifice of the appendix. The specimen from the polypoid lesion revealed lymphocytes infiltration, but no evidence of Crohn's disease. The patient has been followed up carefully in the 6 months since surgery.

Key words
Crohn's disease, appendix

Reprint requests
Yasuyuki Nonaka Department of Surgery, Kobe Red Cross Hospital 5-6-22 Shimoyamatedori, Chuo-ku, Kobe, 650-0011 JAPAN

Accepted
January 31, 2001

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