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. 2011 Apr;4(2):58-63.
doi: 10.4021/gr302w. Epub 2011 Mar 20.

Clinical Significance of Isolated Peri-Appendiceal Lesions in Patients With Left Sided Ulcerative Colitis

Yan Bakman  1 , Jeffry Katz  2 , Chris Shepela  3
Affiliations

Clinical Significance of Isolated Peri-Appendiceal Lesions in Patients With Left Sided Ulcerative Colitis

Yan Bakman et al. Gastroenterology Res. 2011 Apr.

Abstract

Background: Ulcerative colitis is classically described as a condition originating in the rectum and extending proximally towards the cecum. In recent years, a discontinuous peri-appendiceal lesion has been described. Our aim was to evaluate the risk of progression to pancolitis in patients presenting with an isolated peri-appendiceal lesion on ileocolonoscopy.

Methods: Endoscopy databases at three tertiary care centers were searched for patients undergoing ileocolonoscopy for diagnosis or surveillance of ulcerative colitis. Patients with isolated periappendiceal lesions as well as histologically confirmed left sided colitis were enrolled. Controls were defined as patients with left-sided ulcerative colitis without evidence of peri-appendiceal inflammation. The main outcome was the need for escalation of therapy to systemic corticosteroids, immunomodulators or biologic agents. Secondary outcomes were progression to pancolitis or requirement for colectomy. A secondary analysis of other risk factors for proximal extension/progression of colitis was also performed.

Results: We identified 228 patients with ulcerative colitis, 123 were included in the analysis. Four point eight percent of patients had isolated peri-appendiceal lesions. In the group with peri-appendiceal lesions, 47.4% required escalation of therapy vs. 70% in the control group (P = 0.53). There was no difference in progression to pan-colitis or colectomy rates between the two groups. Progression was not predicted by inflammatory markers, age, gender, initial Mayo UC score or IBD therapy utilization.

Conclusions: The presence of isolated peri-appendiceal lesions is not a risk factor for future escalation of therapy for ulcerative colitis and is not correlated with proximal extension of disease.

Keywords: Cecal patch; Inflammatory bowel disease; Peri-appendiceal lesion; Ulcerative colitis; Ulcerative colitis therapy.

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Figures

Figure 1
Figure 1
Peri-appendiceal lesion. (A) Typical endoscopic appearance of periappendiceal inflammation, “cecal patch” with a sharply demarcated border (arrows), seen in a patient with left sided ulcerative colitis. (B) Normal endoscopic appearance of the cecum.
Figure 2
Figure 2
Rates of endoscopic disease progression.
Figure 3
Figure 3
Rates of colectomy between groups.
See this image and copyright information in PMC

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