Appendiceal orifice inflammation (AOI) is observed as skip lesion in distal ulcerative colitis (UC). The endoscopic frequency of AOI is reported to be 7.9% to 76% of distal colitis. UC is a relapsing and remitting disease and a morphological change of the large bowel occurs over time. Patient and physician can easily understand the shape of the whole large bowel not through endoscopic photograph but by roentgenogram of the bowel. Therefore, the authors undertake barium enema study when a diagnosis of UC is made. We have experienced a patient with proctitis in which an appendiceal submucosal tumor (SMT) was suspected on the roentgenogram but it was turned out to be a protruding lesion of AOI. A 16-year-old boy visited us with complaining of blood in his stool for the past 10 days. Sigmoidoscopy revealed mild diffuse inflammation. Crypt abscess was found in biopsy specimen. A diagnosis of UC, proctitis type, was made. A double contrast barium enema study revealed a defect shadow with a smooth surface, length 37 mm, height 12 mm, over the appendix. An appendiceal SMT was suspected. Abdominal ultrasonography and computed tomography were non-contributory. Colonoscopy revealed a spiral inflamed mucosa at the site of an appendiceal orifice. There was an inflammation in the cecum surrounding the orifice. Biopsy specimen of the appendiceal orifice showed inflammatory cells infiltration, goblet cell depletion, and cryptitis. The suspected SMT lesion was concluded to be AOI.
Appendiceal orifice inflammation (AOI) is observed as skip lesion in distal ulcerative colitis (UC) [
On February 16, 2009, a 16-year-old boy visited us with complaining of blood in his stool for the past 10 days. He had bronchial asthma until 6-year-old. Sigmoidoscopy revealed mild diffuse inflammation in the rectum. Crypt abscess was found in his biopsy specimen. Stool culture was negative for pathogens. A diagnosis of UC, proctitis type, was made. Since the symptom was mild, the responsible doctor (MC) proposed to him an educational admission of a short period during his spring vacation. Until admission he was advised to have prudent meals and lead a normal life. He was admitted on March 23, when bloody stool was absent. A routine examination of his blood was normal. Fecal occult blood tests were 213 ng/ml and 140 ng/ml (normal range <100 ng/ml). He was provided 2000 kcal/d of a semi-vegetarian diet (SVD) [
On April the 1st, he was found to have a low grade fever at noon. Therefore, mesalazine (Pentasa), 1.5 g/d, was started, and the fever disappeared. The patient and his mother were provided a dietary guidance of SVD [
Eight months later, after eight months remission, colonoscopy was repeated. The rectum showed a picture of remission. Mild inflammation in the cecum surrounding the orifice disappeared. But protruded spiral inflamed
mucosa was evident as before. He had been well up to the present, December 2013, although he had occasional bloody stool which did not require hospitalization or change of medication.
Inflammatory bowel disease is a lifestyle-related disease mediated mainly with westernized diet [
There is a protruding type of AOI, although it is rare, and it looks like SMT on roentgenogram.