Appendiceal Crohn’s disease: on sonography and CECT

Case contributed by Dr Mohamed Hossam el Deen

Presentation

Acute onset RLQ pain x 24 hour. CBC is 11.000 ERS 120 PPD test -ve

Patient Data

Age: 33
Gender: Male

Sonographic images shows target sign of inflamed retro cecal appendix with peri-appendicular hyperemia. There is also diffuse edematous thickened wall of both cecum and ileum . A picture suggesting inflamed appendix on top of ileocecal inflammatory process.

Ileocecal wall thickening and inflamed, there is also regional mesenteric fat stranding and multiple small regional mesenteric lymphadenitis. The appendix did not filled with oral contrast maybe related to sever wall edema of ileocecal valve region. But it was retrocecal and lateral on ultrasound. There is also gall bladder stone as incidental finding. 

Case Discussion

Appendiceal Crohn’s disease is not a common finding but should be excluded in the case of associated thickened gut wall in the ileocecal region. Supportive data and findings should be carefully studied including regional lymphadenitis.

History of tuberculosis and PPD test result, WBC differential "either leukocyte or lymphocytic predominance". 

The importance of excluding tuberculosis, ulcerative colitis, and lymphoma in cases of appendicitis and cecal lesions is vital as surgical outcome "including possibility of fistula formation"  is different. 

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Case information

rID: 47877
Case created: 6th Sep 2016
Last edited: 7th Sep 2016
Inclusion in quiz mode: Excluded

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