A Case of Crohn's Disease of the Vermiform Appendix

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A 48-year-old woman reported right lower abdominal pain involving mild tenderness in the right lower quadrant but no rebound tenderness and muscle guarding. Her white blood cell count was within normal limit. Barium enema showed a vermiform appendix partially drawn and wall irregularity in the cecum. Colonofiberscopy showed a reddened protrusion at the ostium of the vermiform appendix. A biopsy specimen from the protrusion showed marked infiltration of inflammatory cells and the presence of a multinucleated giant cell. Surgery was conducted under a diagnosis of granulomatous inflammation of the appendix or appendiceal tumor. Ileocolectomy was done to remove a finger-tip-sized tumor in the radix of the appendix. The resected specimen showed 2 protrusions at the ostium of the vermiform appendix involving a longitudinal 12 mm ulcer. Histologic examination showed transmural inflammation, a fissuring ulcer, and noncaseating epithelioid granuloma, indicating as a rare case of Crohn's desease confined to the appenix. This case could be suspected of appendiceal Crohn's disease by preoperarive examination of the biopsy specimen.
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