Granulomatous Appendicitis Research Articles

A CASE REPORT OF GRANULOMATOUS APPENDICITIS

We report a case of granulomatous appendicitis which was pathohistologically diagnosed. A 28-year-old woman complaining of ileocecalalgia was admitted to our hospital. A mass was palpated in the ileocecal region. Ultrasonography and barium meal roentgenography of the small intestine showed an ileocecal tumor, and laparotomy was performed. The tumor, sizing 4.0×3.0×2.0 cm, was hard and originated from the appendix. Mesenteric lymph nodes were swollen. Right hemicolectomy was carried out on a suspicion of malignancy. The cross section of the tumor was yellowish white. The pathohistological diagnosis was granulomatous appendicitis.We pointed out the differential diagnosis between the granulomatous appendicitis and Crohn's disease, and also discussed the infectious disease in the ileocecal region due to Yersinia pseudotuberculosis.

Appendicitis as the initial manifestation of Crohn's disease: radiologic features and prognosis.

Twenty-five patients 15-47 years old presented with appendicitis as the initial manifestation of Crohn's disease. This entity accounted for 1.8% of all appendicitis patients undergoing surgery at our institution during a recent 9-year period. Preoperative radiologic studies in 18 (72%) of 25 cases showed abnormalities indicating the presence of appendicitis or periappendiceal abscess, but not the specific diagnosis of Crohn's disease as the underlying cause. Histopathologic evidence for an isolated, transmural, or granulomatous appendicitis was found in 20 patients; in two of these there was a local recurrence within 3 years after surgery, while 18 others have remained asymptomatic during follow-ups of up to 8 years. In the other five patients Crohn's disease caused appendicitis with concurrent inflammation of the cecum or terminal ileum; three of these cases were complicated by progressive granulomatous ileocolitis within 2 years. The data presented herein indicate that Crohn's disease can originate in and be confined to the appendix, yet manifest clinical symptoms leading to emergency laparotomy; preoperative radiologic findings are similar to those of suppurative appendicitis, but visualization of a markedly thickened appendiceal wall with patent or irregularly narrowed lumen supports the diagnosis of Crohn's appendicitis; and primary Crohn's disease of the appendix has a favorable long-term prognosis after simple appendectomy, despite a 10% incidence of recurrence as granulomatous ileocolitis.

Occurrence of granulomatous appendicitis in rabbits

Granulomatous appendicitis was observed in all of the 45 Japanese white rabbits examined. Histologically, multiple microgranulomas were accompanied with foreign body giant cells and focal calcifications in lymph nodules of appendix. Foreign body giant cells contained hair coat and larvae of Passalurus ambiguus. In addition, the sacculus rotundus and mesenteric lymph nodes were affected with the same lesions. PAS- and Gram- positive bacilli were phagocytized in the microgranulomas and macrophages. They were also stained positively with the immunoperoxidase method for the auto-sera of rabbits. Isolation of these bacilli in pure culture has not yet been accomplished. The occurrence of granulomatous lesions due to tuberculosis, pseudotuberculosis, tularemia and actinomycosis seems unlikely in the present cases because none of these organisms nor characteristic lesions were detected. It was suggested that the Gram-positive bacilli appeared to play a role in granulomatous appendicitis.

Granulomatous appendicitis: Is it Crohn's disease? Report of a case and review of the literature: A.E. Timmcke. Am J Gastroenterol 81:283–287, (April), 1986

Granulomatous appendicitis: Is it Crohn's disease? Report of a case and review of the literature: A.E. Timmcke. Am J Gastroenterol 81:283–287, (April), 1986

Benign cecal lesions associated with appendicitis

Three types of radiologic evidence of abnormalities of the cecum may be noted following appendectomy: (1) the ring-shadow of the inverted appendiceal stump, (2) the nipple-like defect of the non-inverted appendiceal stump and (3) defects associated with adhesions. However, polypoid lesions of the cecum cannot be differentiated from the ring-shadow of the inverted stump in all cases. If the diagnosis is not certain, exploration and biopsy should be performed. If lymphadenopathy is present and the diagnosis is in doubt, resection of the ascending colon is probably the safest procedure. The nipple-like defect should not be confused with any other lesion. If symptoms are associated with lesions compatible with adhesions, the latter should be freed. Three cases are presented: one of granulomatous appendicitis treated by appendectomy; the second of adhesions from the internal inguinal ring to the appendiceal base, treated by lysis of the adhesions; and the third, a silk stitch granuloma of the appendiceal stump, associated with a palpable mass and regional adenopathy, and treated by resection of the ascending colon.