Pediatric Crohn disease presenting as appendicitis: differentiating features from typical appendicitis.
BACKGROUND
The initial presentation of Crohn disease (CD) may mimic acute appendicitis, and preoperative clues may aid in recognizing patients at risk for CD.


METHODS
A retrospective case control study of patients presenting over 10 years compared control patients with appendicitis versus patients presenting with appendicitis who ultimately developed CD. We matched 10 patients of the same age, gender, and perforated versus nonperforated appendicitis status for each of the CD patients. Demographic, laboratory, and clinical data were compared. Additionally, appendectomy specimens of CD patients were genotyped for common NOD2 (nucleotide-binding oligomerization domain-containing protein 2) mutations.


RESULTS
Of 2718 patients treated for appendicitis, 8 subsequently developed CD. Compared to the matched controls, CD patients were found to have lower hemoglobin (10.4 + 1.0 vs. 13.3 + 0.2, p < 0.0001) and mean corpuscular volume (MCV) (72.5 + 3.4 vs. 84.1 + 0.5, p < 0.0001) values, and higher platelets values (444.8 + 42.2 vs. 275.6 + 8.0, p < 0.0001) at initial presentation. Anthropometric z-scores, length of stay, and antibiotic therapy duration did not significantly differ between groups. The NOD2 mutation frequency (25%) was consistent with the currently described CD population.


CONCLUSIONS
Preoperative findings of a low hemoglobin level and MCV count, and a high platelet count in a child presenting with appendicitis warrant further evaluation for CD, as prompt diagnosis allows for optimal treatment and quality of life for these patients.
Division of Gastroenterology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64108, United States. jabass@cmh.edu
Julie A
JA
Bass
Jennifer
J
Goldman
Mary Anne
MA
Jackson
Alessandra C
AC
Gasior
Susan W
SW
Sharp
Amanda A
AA
Drews
Carol J
CJ
Saunders
Shawn David
SD
St Peter
D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000097:blood / Q000209:etiology* / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000235:genetics; D006801:Humans; D053473:Nod2 Signaling Adaptor Protein / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D012372:ROC Curve; D012189:Retrospective Studies
D015415:Biomarkers; C429018:NOD2 protein, human; D053473:Nod2 Signaling Adaptor Protein