Isolated Colitis Limited to the Peri-Appendiceal Orifice Related to Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
A Del Rio Perez, W Xin. University Hospitals Case Medical Center, Cleveland, OH
Background: Isolated chronic colitis limited to the peri-appendiceal orifice region with no accompanied ileitis and chronic colitis in other sites, is not an uncommon finding in routine evaluation for chronic diarrhea. A spectrum of etiologies should be included in the differential diagnosis: the most common being Crohn's disease (CD), drug-induced enterocolitis, especially due to non-steroid anti-inflammatory drugs (NSAIDs) or no clinical significance. NSAIDs have long been implicated to cause specific and non-specific gastrointestinal symptoms, and induce a variety of pathological changes, such as ileitis and isolated colonic ulcer. In this study, we looked at the possible etiology or any clinical significant of the isolated peri-appendiceal orifice colitis.
Design: The biopsy specimens of the peri-appendiceal orifice region were selected by SNOMED search of surgical pathology archives from our hospital system between years of 2006 to 2008. Only the cases with colitis limited to the cecum or peri-appendiceal orifice were selected. Cases with previous diagnosis of colorectal carcinoma or inflammatory bowel diseases were excluded in this study. Electronic medical record was used for follow-up of these patients for a maximum of 3 years after diagnosis.
Results: In total, a group of 23 patients were found to have isolated colitis in peri-appendiceal orifice region. All cases with accompanied terminal ileum or other parts of colon showed no pathological abnormalities. The endoscopic findings ranged from: focal inflammation, erosion, ulcerations, and erythema. The follow-up diagnoses show that 21 % (5/23) of patients had documented histories of routine chronic or acute NSAIDs use. Among these 5 patients, 3 patients had resolution of microscopic findings after cessation of the drugs and repeat colonoscopy. None of the patients developed persistent lower gastrointestinal tract symptoms or inflammatory bowel disease. There were 62 % (14/23) of patients with occasional aspirin usage. There were only 4 % (1/23) of cases that findings were attributed to an infections etiology.
Conclusions: The findings of this study suggest that the isolated colitis in peri-appendiceal orifice region is mainly due to NSAIDs usage. The pathological findings could be reversed after the cessation of the NSAIDs. None of the patients developed Crohn's disease after 3 years followup. A large scale of the study should be warranted to establish the relationship of colitis in appendiceal orifice region with NSAIDs usage in humans.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 59, Wednesday Morning