P134 Pediatric granulomatous appendicitis, how can it be precursor of Crohn Disease?

Guvendir Bakkaloglu, I.(1);Calim Gurbuz, B.(2);Zemheri, I.E.(1);Bakkaloglu,O.K.(3)*;

(1)Health Sciences University- Umraniye Training and Research Hospital, Pathology, Istanbul, Turkey;(2)Basaksehir Cam and Sakura City Hospital, Pathology, Istanbul, Turkey;(3)Istanbul University Cerrahpasa, Gastroenterology, Istanbul, Turkey;


Granulomatous appendicitis (GA) in pediatric age is an entity that is difficult to evaluate, diagnose, and may present with unexpected symptoms, and overlap with other diseases. Since there may be many different causes in its etiology, detailed histopathological examination with clinical correlation is very important. Our aims are to analyse detailed histomorphological features of GA in children, understand the etiology and investigate if it may be a precursor of inflammatory bowl disease (IBD) in the follow ups.


The detailed histopathology and etiology of pediatric and adult GA’s were evaluated retrospectively in two centers between 2016 and June 2022. All cases diagnosed with granulomatous appendicitis in the given date range were included in the study.

Serological, radiological and histomorphological findings of the patients were evaluated within at least 6 months of follow-up and compared with adults.


Of the 2144 pediatric appendectomy specimens, 25 (0.01%) were GA, 12(48%) of them are female and the mean age was 13.96. While interval appendicitis was the most common cause in GA etiology (n:12, 48%), IBD (n:5, 20%) was the second. 4 pediatric patients were diagnosed with Crohn Disease (CD) and one with Ulcerative Colitis in their follow-ups, none of the adults had IBD.

During the follow-ups, mycobacteria was detected in the serology of one case, while actinomycesis was observed in the lumen of another. Crohn's disease may tend to involve the appendix more severely in younger patients. And it may present as the first finding of IBD. It is known that granulomas are more specific for Crohn's disease. In the detailed histopathological examination of cases, non-necrotizing granuloma structure is seen more frequently in CD. Besides, non-necrotizan type granulomas, mucosa involvement of the wall, accompanying exaggerated reactive lymphoid aggregates, and eosinophil count were more common in CD .



Granulomatous appendicitis may be more associated with IBD, especially in childhood patients than in adults. Detailed histopathological examination of CD-specific features can be alarming. However, when a case with GA is encountered, all conditions that may cause granulomatous inflammation should be ruled out serologically and radiologically, and system scanning should be performed very carefully before considering IBD.