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. 2025 Sep:134:111784.
doi: 10.1016/j.ijscr.2025.111784. Epub 2025 Aug 7.

Crohn's disease presenting as acute appendicitis: Case series

Abate Bane Shewaye  1 , Kaleb Assefa Berhane  2 , Samrawit Solomon  2 , Amsalework Daniel  2
Affiliations

Crohn's disease presenting as acute appendicitis: Case series

Abate Bane Shewaye et al. Int J Surg Case Rep. 2025 Sep.

Abstract

Introduction and importance: Crohn's disease (CD) is a chronic, transmural inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract. Its rare involvement of the appendix can mimic acute appendicitis, often leading to misdiagnosis and inappropriate initial management.

Case presentation: We report three patients who presented with right lower quadrant abdominal pain and were initially diagnosed and surgically treated for acute appendicitis. However, all were subsequently found to have ileocecal CD. Each case involved complications such as fistula formation or persistent symptoms, ultimately requiring further surgical intervention and appropriate medical therapy with immunosuppressants and biologics.

Clinical discussion: These cases highlight the diagnostic challenge posed by CD when it presents with symptoms suggestive of acute appendicitis. A history of chronic or recurrent abdominal symptoms, postoperative complications, or atypical findings should raise suspicion for underlying IBD. Timely and accurate diagnosis is crucial to prevent unnecessary surgeries and reduce morbidity.

Conclusion: Misdiagnosis of Crohn's disease as appendicitis led to complications and delayed care. Crohn's disease should be considered in the differential diagnosis of patients presenting with atypical or recurrent right lower quadrant abdominal pain. Early use of fecal calprotectin and imaging can aid diagnosis and improve outcomes in patients with atypical presentations.

Keywords: Appendicitis; Case series; Crohn's disease; Ileocecal disease; Misdiagnosis.

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Conflict of interest statement

Conflict of interest statement The authors report no conflicts of interest in this work.

Figures

Fig. 1
Fig. 1
Colonoscopic image showing a deformed, edematous, and ulcerated nodular ileocecal valve with luminal stenosis, characteristic of Crohn's disease involving the terminal ileum and ileocecal region.
Fig. 2
Fig. 2
Colonoscopic image showing diffusely hyperemic mucosa with scattered ulcers and a narrowed, inflamed ileocecal valve, consistent with active Crohn's disease involving the terminal ileum and cecum.
See this image and copyright information in PMC

References

    1. Williams N.S., Bullstrode C.J.K., O’Connell P.R. Bailey & love’s short practice of surgery, 25th edn. Ann. R. Coll. Surg. Engl. 2010 Mar;92(2):178. doi: 10.1308/003588410X12628812459094. - DOI
    1. Francisco T.-E., David M.-D., Omar P.-B., Rodrigo E.-D., Alejandra Z.-O. Crohn’s disease manifesting as acute appendicitis: case report and review of the literature. World J Surg Surgical Res. 2020;3:1185.
    1. Scheurlen K.M., Parks M.A., Macleod A., Galandiuk S. Unmet challenges in patients with Crohn’s disease. J. Clin. Med. 2023 Aug 27;12(17):5595. doi: 10.3390/jcm12175595. - DOI - PMC - PubMed
    1. Torres J., Burisch J., Riddle M., Dubinsky M., Colombel J.F. Preclinical disease and preventive strategies in IBD: perspectives, challenges and opportunities. Gut. 2016 Jul;65(7):1061–1069. doi: 10.1136/gutjnl-2016-311785. - DOI - PubMed
    1. Jayasooriya N., Baillie S., Blackwell J., Bottle A., Petersen I., Creese H., Saxena S., Pollok R.C., POP-IBD study group Systematic review with meta-analysis: time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease. Aliment. Pharmacol. Ther. 2023;57(6):635–652. doi: 10.1111/apt.17370. - DOI - PubMed

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