Granulomatous appendicitis: Crohn's disease, atypical Crohn's or not Crohn's at all?

Background: Crohn's disease isolated to the appendix has primarily been documented in case reports. We contribute a series with longterm followup and a literature review.

Study Design: A retrospective review of 1,133 consecutive appendectomy specimens over the 6-year period ending in 1994 identified seven patients with isolated granulomatous appendicitis. Two patients presented before the review period. These nine patients are reviewed and 156 patients identified in the world literature.

Results: Granulomatous appendicitis usually presents as an indolent course of appendicitis. No patient developed enterocutaneous fistula after appendectomy in our series. A mean followup of 7.3 years in our patients revealed no evidence of Crohn's disease.

Conclusions: Granulomatous inflammatory disease isolated to the appendix differs from typical Crohn's disease with a decreased occurrence of enterocutaneous fistulas and rare recurrence. Consequently, isolated granulomatous appendicitis without small bowel or cecal involvement may not represent true Crohn's disease. Patients can be treated with minimal morbidity by appendectomy alone. If isolated granulomatous appendicitis does represent Crohn's disease, its longterm course in the majority of patients is extremely benign.