Yang S S, Gibson P, McCaughey R S, Arcari F A, Bernstein J
Ann Surg. 1979 Mar;189(3):334-9. doi: 10.1097/00000658-197903000-00014.
Fourteen patients with primary Crohn's disease of the appendix have been seen in a 12 year period. These patients represent 12.8% of the total number undergoing surgical resection because of Crohn's disease. Twenty-three cases of appendiceal Crohn's disease have been previously reported in the literature. A correct preoperative diagnosis is rarely made; the usual diagnosis is that of acute appendicitis or appendiceal abscess. The removed appendix in twelve of our 14 cases had marked thickening of the wall with transmural fibrosis and often with granulomatous inflammation. The enlarged appendix had an external appearance similar to that of ileal Crohn's disease, and we consider a correct surgical diagnosis might be possible with better awareness of its existence. The diagnosis might be suspected earlier when the clinical course of apparent appendicitis is protracted or atypical. Contrary to the previous estimation of high recurrence rate, this series and the cumulative evidence in the literature show a relatively low rate at 14%. The feared fistula formation following the removal of the appendix has not been seen in either our series or the literature. These patients, however, merit long-term follow-up.
在12年的时间里，共诊治了14例原发性阑尾克罗恩病患者。这些患者占因克罗恩病接受手术切除患者总数的12.8%。此前文献中已报道过23例阑尾克罗恩病病例。术前很少能做出正确诊断；通常的诊断是急性阑尾炎或阑尾脓肿。在我们的14例病例中，有12例切除的阑尾壁明显增厚，伴有透壁纤维化，且常伴有肉芽肿性炎症。肿大的阑尾外观与回肠克罗恩病相似，我们认为如果能更好地认识到其存在，可能做出正确的手术诊断。当明显阑尾炎的临床病程迁延或不典型时，可能更早怀疑该诊断。与之前对高复发率的估计相反，本系列病例以及文献中的累积证据显示复发率相对较低，为14%。在我们的系列病例或文献中均未见到阑尾切除后令人担忧的瘘管形成情况。然而，这些患者值得长期随访。
