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 ).