A patient with improvement of ulcerative colitis after appendectomy

Recently, several retrospective studies have shown an inverse association b etween appendectomy and development of ulcerative colitis. We describe a 21 -year-old man with distal ulcerative colitis and appendiceal involvement. T he patient passed bloody stools continually during the 3 years before admis sion. Macroscopic and microscopic findings showed chronic moderate inflamma tion of the appendix and rectum. The ratio of CD4 to CD8 lymphocytes isolat ed from rectal and appendiceal mucosa was increased (4.3 and 3.8, respectiv ely) compared with controls (n = 11; 1.0 in the rectum and 1.4 in the appen dix). Clinical symptoms and colonoscopic and microscopic findings improved significantly after appendectomy. In addition, the amount of interferon gam ma secreted from rectal lymphocytes was reduced to 83 pg/mL after surgery ( before appendectomy, 254 pg/mL). However, interleukin 4 production was belo w detectable levels both before and after appendectomy. These findings sugg est that appendectomy resulted in altered T-helper (Th)1/Th2 balance in thi s patient. In the 3 years since surgery, the patient has been in good condi tion without recurrence of symptoms. This is the first report demonstrating therapeutic benefit of appendectomy in a patient with ulcerative colitis a nd potential mechanistic relationship.