Abstract
A 50-year-old man was admitted to our hospital complaining of recurring right lower quadrant abdominal pain. Barium enema showed an elevated lesion with smooth surface at the orifice of the appendix, but no abnormality in the colon. Four months later, re-examination of barium enema disclosed mucosal coarseness and tiny ulcerations in the rectum and sigmoid colon, normal findings from the descending colon to the cecum, and more grown elevated lesion in the appendix. Colonoscopy showed the same findings as barium enema. Biopsy specimen showed infiltration of inflammatory cells and crypt abscess in the mucosa of elevated lesion in the appendix and the sigmoid colon. The mucosa of the ascending colon was normal. Appendectomy and partial resection of the cecum were performed. The histological diagnosis was appendicitis due to ulcerative colitis, and the mucosa of the resected cecum was normal. Our diagnosis of this case was appendicitis associated with ulcerative colitis, so-called 'ulcerative appendicitis'. This is the first case of ulcerative appendicitis in Japan, which was advocated by Cohen et al. These cases may be misdiagnosed as Crohn's disease because of their 'skip' involvement of the appendix.
