A young female patient presented with complaints of RLQ pain

A young female patient presented with complaints of RLQ pain, diarrhea and nausea of 3 weeks duration. It is suspected that she may have developed inflammatory bowel disease. You perform a diagnostic laparoscopy and visualize the organ below. At the same time, you note that the presence of enlarged mesenteric lymph nodes and erythema of the ileum. What is the next step in your management?

a. Appendectomy

b. Small bowel resection

c. Observation

d. Appendectomy & small bowel resection

e. Lymph node biopsy

  1. If a patient is suspected of having inflammatory bowel disease like Crohn disease, then it is vital that you do not remove a normal appendix.

  2. First there is ample literature indicating that removal of the appendix in young patients later leads to development of Crohn disease

  3. If you remove a normal appendix in a patient suspected of having acute inflammation of the small bowel chances are that the appendiceal stump will form a fistula, which is a major league problem.

  4. Best to leave the normal appendix alone.No biopsy should be done as the diagnosis of Crohn is clinical and radiological.

  5. In most other patients, the appendix is removed so that there is no more confusion with the diagnosis in future.