Crellin Adam James, Musbahi Omar, Onwu Natasha, Singh Sandeep
Medical Sciences Division, Oxford University, Oxford, UK
Oxford University Clinical Academic Graduate School, Oxford University, Oxford, UK.
BMJ Case Rep. 2020 Feb 28;13(2):e232549. doi: 10.1136/bcr-2019-232549.
A 30-year-old man with a history of severe right iliac fossa pain was referred to the surgical emergency unit. His symptoms began 3 days prior as mild, non-specific abdominal pain which progressively localised to the right iliac fossa and worsened in severity. Investigations were suggestive of acute appendicitis, and therefore a laparoscopic appendicectomy was planned. Laparoscopy revealed a thickened, necrotic appendix with a mass at the base of the appendix, in keeping with the appearance of an appendiceal malignancy. Subsequently a right hemicolectomy was performed. Histology revealed active chronic inflammation and granulomas highly suggestive of appendiceal Crohn's disease. Since, the patient has made a good recovery and presently shows no further signs of Crohn's disease. This case is demonstrative of one of many rare findings on histological examination of the appendix. It emphasises the need for a wide differential when investigating right iliac fossa pain.
一名有严重右下腹疼痛病史的30岁男性被转诊至外科急诊室。他的症状始于3天前，起初为轻度、非特异性腹痛，逐渐局限于右下腹且疼痛程度加重。检查提示急性阑尾炎，因此计划进行腹腔镜阑尾切除术。腹腔镜检查发现阑尾增厚、坏死，阑尾根部有肿物，符合阑尾恶性肿瘤的表现。随后进行了右半结肠切除术。组织学检查显示有活跃的慢性炎症和肉芽肿，高度提示阑尾克罗恩病。此后，患者恢复良好，目前未再出现克罗恩病的迹象。该病例展示了阑尾组织学检查中众多罕见发现之一。它强调了在调查右下腹疼痛时需要进行广泛鉴别诊断。
