GRANULOMATOUS APPENDICITIS - CROHNS-DISEASE, ATYPICAL CROHNS, OR NOT CROHNS AT ALL

Background: Crohn's disease isolated to the appendix has primarily bee n documented in case reports. We contribute a series with longterm fol lowup and a literature review. Study Design: A retrospective review of 1,133 consecutive appendectomy specimens over the 6-year period endin g in 1994 identified seven patients with isolated granulomatous append icitis. Two patients presented before the review period. These nine pa tients are reviewed and 156 patients identified in the world literatur e. Results: Granulomatous appendicitis usually presents as an indolent course of appendicitis. No patient developed enterocutaneous fistula after appendectomy in our series. A mean followup of 7.3 years in our patients revealed no evidence of Crohn's disease. Conclusions: Granulo matous inflammatory disease isolated to the appendix differs from typi cal Crohn's disease with a decreased occurrence of enterocutaneous fis tulas and rare recurrence. Consequently, isolated granulomatous append icitis without small bowel or cecal involvement may not represent true Crohn's disease. Patients can be treated with minimal morbidity by ap pendectomy alone. If isolated granulomatous appendicitis does represen t Crohn's disease, its longterm course in the majority of patients is extremely benign. (C) 1997 by the American College of Surgeons.