Non-Operative Management of Acute Appendicitis in a Patient with Ulcerative Colitis

• Published in: Surgical infections case reports Vol. 1; no. 1; pp. 161 - 164
• Main Authors: Tierney, Joshua, Melvin, Willie V., May, Addison K., Bonatti, Hugo
• Format: Journal Article
• Language: English
• Published: Mary Ann Liebert, Inc 01.11.2016
• Subjects: Case Report
• ISSN: 2469-4037
• DOI: 10.1089/crsi.2016.0038

Background: Right lower quadrant (RLQ) pain is a common reason for visits to the emergency department. Acute appendicitis is often suspected but multiple other differential diagnoses must be taken into consideration including inflammatory bowel disease (IBD). A computed tomography (CT) scan of the abdomen is used routinely in adults presenting to the emergency department with RLQ pain. Ulcerative colitis (UC) may affect the appendix in cases of pancolitis, however, skip lesions in the appendix have been reported rarely. Non-operative management of appendicitis has gained increasing acceptance. Case Presentation: A 49-year-old male with UC, who was non-compliant with therapy, presented to the emergency department with acute RLQ pain and diarrhea. Computed tomography scan showed a thickened and dilated appendix, peri-appendiceal stranding, and mild thickening of the cecum. We suspected the patient had a flare of UC involving the appendix and opted for non-operative management with intravenous antibiotics. His pain improved and colonoscopy revealed active pancolitis involving the cecum. Biopsies confirmed the diagnosis of a flare of UC. He was discharged with a course of antibiotics and followed as an outpatient and started on medication for UC. He remained well during follow-up without evidence of recurrent appendicitis. Discussion: Increasing evidence is available to support non-operative management of patients with acute appendicitis. We propose that patients with IBD who present with acute RLQ pain and CT findings of acute appendicitis should be managed non-operatively and a colonoscopy should be done to exclude active IBD. Appendectomy in a patient with active colitis may have an increased risk of morbidity such as stump leak or cecal perforation and may delay initiation of appropriate therapy.