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Periappendiceal Inflammation in Pediatric Ulcerative Colitis

Strisciuglio, Caterina MD*; Giannetti, Eleonora MD*; Giugliano, Francesca Paola MD*; Greco, Luigi MD, MSc (MCH), DCH*; Campione, Severo MD; D’ Armiento, Mariarosaria MD; Staiano, Annamaria MD*; Miele, Erasmo MD, PhD*

doi: 10.1097/MIB.0b013e318281f469
Original Clinical Articles

Background: An involvement of the appendiceal orifice as a distintive skip lesion in adults with left side ulcerative colitis (UC) has been reported. The aim of our prospective study was to evaluate, by endoscopy and histology, the prevalence of periappendiceal inflammation (PAI) in children affected by UC.

Methods: Fifty of 77 consecutive children undergoing total colonoscopy, who had a diagnosis of UC not extended beyond the hepatic flexure were enrolled.

Results: PAI was endoscopically present in 16 of 50 patients (32%) with UC. Patients were divided in 2 groups: group A included the 16 patients with PAI, whereas group B included 34 patients without PAI. We found that among the 2 groups, PAI was more frequent in patients with new diagnosis than in those with pre-existing UC (P = 0.016). At index colonoscopy, the patients of group A had a significant major extent of disease (P = 0.013). Moreover, the histologic grade of inflammation at the ascending colon was significantly higher in group A than in group B (P = 0.014). Clinical activity, measured by pediatric ulcerative colitis activity index, and use of medication did not show significant differences among groups (P = 0.464 and P = 0.723, respectively). The use of immunosuppressant was significantly higher in group A than in group B.

Conclusions: PAI is a frequent skip lesion in children with UC. It seems more frequent in patients with new diagnosis, and it is associated with a major extent of the disease and with a higher grade of histologic inflammation at the ascending colon.

Article first published online 2 April 2013

*Department of Pediatrics, University of Naples “Federico II”, Italy; and

Department of Biomorphological and Functional Sciences, Section of Pathology, University of Naples “Federico II”, Naples, Italy.

Reprints: Annamaria Staiano, MD, Department of Pediatrics, University “Federico II,” Via S. Pansini, 5, 80131 Naples, Italy (e-mail:

The authors have no conflicts of interest to disclose.

Received November 08, 2012

Accepted November 19, 2012

© Crohn's & Colitis Foundation of America, Inc.
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