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Unexpected outcome (positive or negative) including adverse drug reactions
Case report
Appendiceal Crohn’s disease: a rare differential of right iliac fossa pain
  1. Adam James Crellin1,
  2. Omar Musbahi2,
  3. Natasha Onwu3 and
  4. Sandeep Singh4
  1. 1Medical Sciences Division, Oxford University, Oxford, UK
  2. 2Oxford University Clinical Academic Graduate School, Oxford University, Oxford, UK
  3. 3Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  4. 4Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to Mr Adam James Crellin; adam.crellin{at}hmc.ox.ac.uk

Abstract

A 30-year-old man with a history of severe right iliac fossa pain was referred to the surgical emergency unit. His symptoms began 3 days prior as mild, non-specific abdominal pain which progressively localised to the right iliac fossa and worsened in severity. Investigations were suggestive of acute appendicitis, and therefore a laparoscopic appendicectomy was planned. Laparoscopy revealed a thickened, necrotic appendix with a mass at the base of the appendix, in keeping with the appearance of an appendiceal malignancy. Subsequently a right hemicolectomy was performed. Histology revealed active chronic inflammation and granulomas highly suggestive of appendiceal Crohn’s disease. Since, the patient has made a good recovery and presently shows no further signs of Crohn’s disease. This case is demonstrative of one of many rare findings on histological examination of the appendix. It emphasises the need for a wide differential when investigating right iliac fossa pain.

  • inflammatory bowel disease
  • crohn's disease
  • surgery
  • gastrointestinal surgery
  • general surgery

https://doi.org/10.1136/bcr-2019-232549

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    Footnotes

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    • Contributors AJC identified the case, collated patient notes, obtained consent, and planned, drafted and revised the paper. AJC is the guarantor. OM revised multiple drafts of the paper. NO provided the histological results and images, and revised the draft paper. SS was responsible for the patient’s care and revising the draft paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.