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PubMed2005

[Crohn's disease of the appendix].

Crohn's disease limited to the appendix is uncommon. Clinically, it is likely to mimic acute appendicitis. It is more frequent in young people and definitive diagnosis is histological. We present a series of seven cases of Crohn's disease of the appendix that were treated in our surgery service over the past 12 years. The seven patients had pain in the lower right quadrant. In all patients, the preoperative diagnosis was acute appendicitis and appendectomy was performed. Histopathological evaluation was required for diagnosis. In the postoperative course, one patient was diagnosed with colonic Crohn's disease, and outcome was favorable with medical treatment. Although isolated Crohn's disease of the appendix is a rare entity, it should be considered in the preoperative differential diagnosis of patients with right lower quadrant pain and a protracted preoperative course mimicking acute appendicitis. Disease recurrence elsewhere in the alimentary tract is uncommon.

Adolescent↗
PubMed1989

Cytomegalovirus and appendiceal perforation in a patient with acquired immunodeficiency syndrome.

We have reported the case of a patient with AIDS who had appendiceal perforation and periappendiceal abscess. Extensive infection with cytomegalovirus was found in the appendix; no other pathogen could be implicated in the perforation. This case emphasizes the broad spectrum of disease due to cytomegalovirus, particularly in patients with AIDS and other immunodeficiencies.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Granulomas of the appendix: is it Crohn's disease?

An epidemiologic study was performed 1) to estimate the occurrence of epithelioid granulomas in the appendix wall among patients in whom an appendectomy had been performed, 2) to identify patients with granulomas in the appendix who had symptoms and history compatible with Crohn's disease, and 3) to estimate the long-term prognosis. Within a 5-year period 6051 patients in Copenhagen County underwent appendectomy. Six patients (0.1%) had epithelioid granulomas of the appendix (0.2 per 10(5) inhabitants per year). Follow-up of the six patients for 9-11 years (median, 9.5 years) showed that all had been free of gastrointestinal symptoms since the operation. Among the 373 patients diagnosed as having Crohn's disease in Copenhagen County between 1962 and 1987, 3 patients had their disease initially confined to the appendix. Follow-up in these patients showed no recurrence within a median of 6 years (range, 4-7 years). Patients with epithelioid granulomas of the appendix have an excellent long-term prognosis, which could be explained by the fact that the condition seems to be unrelated to Crohn's disease.

Adolescent↗
PubMed1998

Enterohepatic lesions in SCID mice infected with Helicobacter bilis.

Helicobacter bilis is a recently identified species that colonizes the intestine and liver of mice. In immunocompetent mice, infections have been associated with mild hepatitis, and in immunocompromised mice, inflammatory bowel disease has been induced by intraperitoneal inoculation of the organism. We report inoculation of 6-week-old C.B-17 scid/scid mice by gastric gavage with approximately 10(7) H. bilis colony-forming units. Groups of mice were euthanized and necropsied 12, 24, and 36 weeks after inoculation. Mild to moderate proliferative typhlitis was evident in all mice at 12 and 36 weeks after inoculation and in most mice 24 weeks after inoculation. Mild to severe chronic active hepatitis was detected in 10 of 10 male mice and 3 of 10 female mice. These results indicate that H. bilis can cause moderate to severe enterohepatic disease in immunocompromised mice.

Animals↗
PubMed1986

Crohn's disease isolated to the appendix: truths and fallacies.

Twenty-five cases of Crohn's disease confined to the appendix were reported in eight hospitals in Israel during a 15-year period. Review of the histologic slides confirmed the diagnosis in 22 cases. Re-evaluation of these 22 patients included physical examination and radiologic studies of the small and large bowel. Rectosigmoidoscopy was performed in 16 patients. Signs and symptoms of Crohn's disease at other sites in the gastrointestinal tract did not occur during follow-up periods of two to 15 years (mean, 6.4 years) after appendectomy. This study and a review of the literature indicate that in most cases (93 per cent) Crohn's disease initially limited to the appendix is not a predictor of subsequent involvement of another portion of the bowel. It is concluded that the so-called Crohn's disease isolated to the appendix is a form of chronic granulomatous and follicular appendicitis of unknown etiology that is unrelated nosologically in the majority of the cases to Crohn's disease proper.

Adolescent↗
PubMed1991

[Rosai-Dorfman disease of the mesenteric lymph nodes and appendix. Secondary to salmonellosis?].

A 28 year-old female patient was operated for acute abdominal pain. At the surgical intervention the mesenteric nodes turned out to be enlarged and the appendix was apparently normal. Microscopically, the changes observed were of the Rosai-Dorfman disease type in the appendix as well as in the nodes. A salmonella D was cultivated in the mesenteric nodes. This association, which has not been described in the literature, permits us to comment clinicopathological aspects, poorly defined, with special reference to the possibility that some instances of Rosai-Dorfman disease could be secondary to an infectious process.

Abdomen, Acute↗
PubMed1986

Nonspecific ulcer of the caecum. Reports of 3 cases.

Benign ulcer of the caecum may mimic acute appendicitis or cancer of the colon. The aetiology is unknown. Most patients are operated on, and the pathologist's report may be unexpected. The ulcer may be diagnosed at colonoscopy and conservatively treated. Diseases which must be excluded are cancer and specific inflammatory, infectious and parasitic conditions.

Adult↗
PubMed1998

A case of Behçet's syndrome with supeior vena cava syndrome.

Behçet's syndrome is a multi-systemic and chronic disorder that affects many organs. It has been suggested that the diagnosis was based on the presence of the 'major' and 'minor' clinical criteria. When thromobophlebitis, arthritis, central nervous system or gastrointestinal lesions are also present. Behçet's syndrome will be thought to be present in the appropriate geographic area. We report a case of superior vena cava syndrome caused by Behçet's disease in a 40-year-old man with recurrent oral aphthous ulcers and skin rashes on the anterior chest wall. There were multiple thrombosis of the superior vena cava, innominate and subclavian veins. This patient also had a solitary cecal ulcer with an ileocecal fistula and downhill varix. The chest CT, veno-cavography, pulmonary angiography and colon study were taken and follow-up was performed.

Adult↗
PubMed2005

Jejunal Crohn's disease is associated with a higher postoperative recurrence rate than ileocaecal Crohn's disease.

OBJECTIVE: Crohn's disease is a chronic inflammatory, panintestinal disease of uncertain aetiology. The recurrence rate of Crohn's disease, often taken as the time when further surgical procedure is undertaken, has been reported to be as high as 76% in 10 years. The site of the disease has not yet been associated with the recurrence rate of Crohn's disease. The aim of the study was to compare the outcome of patients who were surgically treated for jejunal Crohn's disease to those whose diseases was confined to the ileocaecal region. METHOD: The information was tracked from our database of 724 surgically treated Crohn's disease patients between 1943 and 2002. Twenty-eight patients with jejunal Crohn's disease at their first operation (12 jejunum alone, 16 also involving other sites) were identified. For each of these patients, 3 patients with ileocaecal Crohn's, matched for age, sex, and smoking habits (n = 84) were identified as controls. RESULTS: The median age in both groups was 21 years (range 16-52 years) with a median follow-up period of 19 years. The 3, 5 and 10 years re-operation rate for the groups with jejunal disease were 43%, 50% and 61% compared to 22%, 30% and 51% with ileocaecal disease, respectively. CONCLUSIONS: The presence of jejunal Crohn's disease is associated with a higher rate of early disease recurrence compared to ileocaecal disease but long-term recurrences rate do not differ significantly.

Adolescent↗
PubMedDate not supplied

[Abdominal actinomycosis simulating Crohn's disease].

Actinomycosis is a rare chronic infectious disease that usually develops abscesses and fistulas. It can also mimic other diseases such as cancer, inflammatory bowel diseases or diverticulitis. We present the case of a 67-year-old woman with an unusual form of actinomycosis. Clinically, the disease simulated an inflammatory bowel disease. Computerized axial tomography, intestinal transit and colonoscopy were performed and the suspected 1 diagnosis continued to be inflammatory bowel disease. The definitive diagnosis was made after histopathological study of the surgical specimen. We highlight the diagnostic difficulty of this rare disease and the importance of prolonged antibiotic treatment.

Actinomycosis↗
PubMed2004

Eosinophilic gastroenteritis: presentation of two patients with unusual affect of terminal ileum and caecum with manifestations of acute abdomen and literature review.

Eosinophilic gastroenteritis is a rare disease; the long-term personal history with digestive symptoms and the course of the disease with relapses and remissions is the key for the disease to be suspected. Endoscopy, CT scan and sonographic studies may provide important indirect signs of the disease and in combination with histological examination the diagnosis can be achieved. The administration of corticosteroids is an important factor for the treatment or the remission of the disease. In this study two cases with unusual location of the disease, on the terminal ileum and caecum, are presented and a literature review is attempted. The disease process, clinical and laboratory findings as well as the surgical approach used are described. Eosinophilic gastroenteritis is a very rare disease with its surgical complications. The disease is a non-surgical disease, thus presurgical diagnosis is important because the entity discussed can be under control by conservative treatment. A high disease suspicious index must be kept in the physicians' mind.

Abdomen, Acute↗
PubMed1975

Incidence of Crohn's disease at Groote Schuur Hospital during 1970-1974.

In the period 1970-1974, 45 patients with Crohn's disease were seen. The incidence of the disease seems to be increasing. Twenty-nine of the patients were White, and 16 Coloured. The disease involved the small bowel alone in 9 patients, the ileocaecal region in 17, the large bowel alone in 4 and both the small and the large bowel in 15. Alone or in combination, abdominal cramps and diarrhoea were the commonest modes of presentation. The type of therapy used is discussed. Only 10 patients in this study have not as yet required surgery. Salazopyrin, steroids, antibiotics and azathioprine have been used with varying success in the treatment of most of the patients. Crohn's disease has a high degree of morbidity, but a low mortality rate.

Adolescent↗
PubMed2000

The role of endogenous steroid hormones in the generation of T helper 2-mediated autoimmunity in mercuric chloride-treated Brown-Norway rats.

Injection of Brown-Norway rats with mercuric chloride (HgCl2) activates a T helper type 2 (Th2) autoimmune response, with production of a number of autoantibodies and vasculitis primarily affecting the gut. Glucocorticoids have been shown to suppress Th1 and to promote the development of Th2-type responses. Conversely dehydroepiandrosterone (DHEA) promotes Th1 responses with suppression of Th2 responses. This study set out to define the role of these hormones in this animal model. Rats were adrenalectomized (Adx) with no steroid replacement (n = 11), Adx with basal steroid replacement given by a 25 mg corticosterone pellet inserted subcutaneously (n = 13), or sham-Adx (n = 14) prior to administration of HgCl2. In both groups of Adx animals there was a delay in the production of immunoglobulin E (IgE) and serum concentrations on day 9 were marginally lower (P = 0.035, repeated measures ANOVA). All of the animals Adx with no steroid replacement and two Adx animals with steroid replacement died between 10 and 14 days after HgCl2 challenge. There was no difference in the severity of caecal vasculitis between the groups. A significant increase in adrenal size was noted following administration of HgCl2. Administration of subcutaneous DHEA implants (100 mg and 200 mg) had no significant effect on IgE concentrations or severity of vasculitis. These observations do not support the hypothesis that corticosterone and DHEA play a central role in setting the Th1/Th2 balance in this experimental Th2-mediated autoimmune disease; in contrast with the Th1-mediated autoimmune disease experimental allergic encephalomyelitis where corticosterone plays a key role in immunoregulation.

Adrenal Glands↗
PubMed1987

Periappendiceal abscesses: percutaneous drainage.

Percutaneous abscess drainage was performed in 21 patients who had periappendiceal abscesses. Fifteen patients had de novo abscesses, while six patients had persistent postsurgical abscesses. Nineteen of the 21 percutaneous drainages were successful. After percutaneous abscess drainage, interval appendectomy was simple and uneventful in all 14 patients in whom it was performed; four patients had appendices removed prior to percutaneous abscess drainage, and three elderly patients have not required appendectomy (follow-up 1 1/2-3 1/2 years). Percutaneous catheter drainage of periappendiceal abscess performed with computed tomographic guidance is effective and safe. Its benefits include imaging demonstration of the abscess; avoidance of an operation for abscess drainage; temporization of extremely ill patients; simplification of appendectomy, which is made elective; obviation of all operations in selected patients (e.g., elderly or with cardiopulmonary disease); and reduction of hospital stay and cost.

Abscess↗
PubMed1983

Fever of unknown origin: a follow-up investigation of 34 patients.

34 patients hospitalized for fever of unknown origin (FUO) were subjected to a follow-up investigation on the average 5 yr after the hospital stay. Two patients had died of a disease related to FUO: one had adenocarcinoma with an unknown primary site and the other a supposed autoimmune disease. In one case the cause of FUO was a periappendicular abscess. A woman continued to have periods of fever with high ESR. In the remaining 30 cases the cause of FUO had apparently been a self-limited, benign disease. In contrast to an earlier series from our clinic, no cases of tuberculosis were revealed.

Abscess↗
PubMed2000

Herniation of the hepatic flexure through the foramen of Winslow: a case report.

Herniation through the foramen of Winslow is among the rarest of internal hernias. Predisposing factors include an enlarged epiploic foramen, a mobile cecum and ascending colon, and an abnormal length of small bowel mesentery. Obstruction, strangulation, and perforation with associated metabolic and septic sequelae are the major complications associated with this disease. We report a case of herniation through the foramen of Winslow in which the diagnosis was established preoperatively.

Aged↗