Abstract
This case report describes the clinical course of a 64-year-old male
with intermittent abdominal pain attributed to recurrent ulcers at the
appendiceal orifice. Initial investigations in November 2019 revealed
chronic gastritis and ulcers at the appendiceal orifice, prompting
consideration of ulcerative colitis. The patient responded well to
mesalazine therapy, experiencing relief from symptoms and improved
colonoscopy findings in May 2020. Despite discontinuing medication, a
recurrence of symptoms in August 2021 led to a repeat colonoscopy
showing renewed ulcers. Mesalazine was reinstated, resulting in symptom
resolution and improved colonoscopy findings by December 2021. However,
in May 2023, a subsequent recurrence of abdominal pain and
colonoscopy-confirmed mucosal changes at the appendiceal orifice
prompted reintroduction of mesalazine. The patient remains under regular
monitoring on mesalazine therapy. This case highlights the challenges in
managing recurrent appendiceal ulcers and the importance of long-term
therapeutic vigilance in suspected ulcerative colitis cases.
Keywords ulcerative colitis, appendiceal orifice, mesalazine
INTRODUCTION
Ulcerative colitis (UC) is a chronic non-specific inflammatory disease
of the gastrointestinal tract, often originating in the rectum and
progressing retrograde to involve the entire colon and the terminal
ileum. Affection of the appendix opening is observed in some UC
patients, although isolated involvement of the appendix in UC is rarely
reported. Herein, we present a case of recurrent UC with exclusive
involvement of the appendix, highlighting that clinical manifestations
of UC may atypically manifest as isolated appendiceal involvement.
Isolated inflammation of the appendix mucosa is a characteristic feature
of ulcerative colitis and may serve as an indicator of disease activity
and prognosis. This case report examines the intricate clinical journey
of a 64-year-old male with intermittent abdominal pain attributed to
recurrent ulcers localized at the appendiceal orifice. The patient’s
diagnostic odyssey began with findings of chronic gastritis and
subsequent identification of appendiceal ulcers, prompting suspicion of
ulcerative colitis. The report tracks the patient’s response to
mesalazine therapy, the recurrence of symptoms despite initial
improvement, and the therapeutic challenges encountered in managing this
unique manifestation. This case underscores the complexities in
diagnosing and managing ulcerative colitis, especially when marked by
recurrent focal lesions, emphasizing the significance of continual
vigilance and individualized therapeutic approaches.
CASE REPORT
A 64-year-old male presented with intermittent abdominal pain. He had a
history of gastroesophageal reflux disease (GERD) but no other
significant medical history. In November 2019, the patient initially
sought medical attention due to intermittent right lower abdominal pain
and sporadic loose stools. Subsequent investigations revealed chronic
gastritis upon further evaluation with esophagogastroduodenoscopy, and
colonoscopy indicated the presence of ulcers at the appendiceal orifice
(Figure 1 ). There were no apparent signs of significant
erythema, erosion, or ulceration in other areas of the colon. Capsule
endoscopy and abdominal-pelvic CT scans showed no notable abnormalities.
Biopsy of the ulcerated appendiceal orifice during colonoscopy revealed
moderate chronic mucosal inflammation with mild active changes,
glandular hyperplasia, lymphoid tissue hyperplasia, and evidence of
acute cryptitis (Figure 2 ).