[Isolated Crohn's disease of the appendix as a source of enterorrhagia].
BACKGROUND
Crohn's disease confined to the appendix is relatively rare as a sole primary manifestation of the disease. Young people are more affected. The medical history and the physical examination are similar to the findings in acute appendicitis, but the manifestations are protracted. On physical examination there are signs of peritoneal irritation and an abdominal mass is palpable in the right iliac fossa.


OBJECTIVE
To report a case of Crohn's disease confined to the appendix and presenting with enterorrhagia. The source of the bleeding was localized by colonoscopy.


METHODS
A 16-year old caucasian male without past history of gastrointestinal symptoms, presented with two episodes of enterorrhagia within a period of one year. In the second episode colonoscopy identified the appendicular ostium as the source of bleeding.


RESULTS
At operation the cecum and terminal ileum were normal in thickness and texture, and an inflammatory appendix adherent to the omentum was removed. Microscopically there were non-caseating granulomas, intense infiltration of the wall with plasma cells, lymphocytes and macrophages. The patient has not suffered recurrence, and a colonoscopy realized 2 years after the operation did not show signs of Crohn's disease.


CONCLUSIONS
This case, like others in the literature, appendectomy is curative, but a 5-year follow-up is mandatory. When a young patient presents with enterorrhagia, this diagnosis has to be considered.
Lima
Sizenando Ernesto de
SE
Hospital Samaritano, São Paulo, SP.
Speranzini
Manlio Basílio
MB
Guiro
Marcos Pacheco
MP
D000293:Adolescent; D001062:Appendectomy; D001065:Appendix / Q000601:surgery; D002429:Cecal Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male