Non-Operative Management of Acute Appendicitis in a Patient with Ulcerative Colitis

Joshua Tierney,Addison K May,Hugo Bonatti,Willie V Melvin

doi:10.1089/crsi.2016.0038

Abstract

Abstract Background: Right lower quadrant (RLQ) pain is a common reason for visits to the emergency department. Acute appendicitis is often suspected but multiple other differential diagnoses must be taken into consideration including inflammatory bowel disease (IBD). A computed tomography (CT) scan of the abdomen is used routinely in adults presenting to the emergency department with RLQ pain. Ulcerative colitis (UC) may affect the appendix in cases of pancolitis, however, skip lesions in the appendix have been reported rarely. Non-operative management of appendicitis has gained increasing acceptance. Case Presentation: A 49-year-old male with UC, who was non-compliant with therapy, presented to the emergency department with acute RLQ pain and diarrhea. Computed tomography scan showed a thickened and dilated appendix, peri-appendiceal stranding, and mild thickening of the cecum. We suspected the patient had a flare of UC involving the appendix and opted for non-operative management with intravenous antib...

Highlights

Ulcerative colitis is a continuous disease, in rare cases skip lesions
Right lower quadrant (RLQ) pain is a common reason for visits to the emergency department
Appendiceal inflammation on computed tomography (CT) scan in the appropriate clinical setting is accepted as grounds for appendectomy

Summary

Introduction

Ulcerative colitis is a continuous disease, in rare cases skip lesions The appendix may be involved in the process, in the case of cecal involvement ulcerative appendicitis may represent a skip lesion [10,11,12]. His CT scan was significant for an inflamed appendix consistent with acute appendicitis (Fig. 1).

Results

Conclusion