Relationship between appendectomy, appendicitis and ulcerative colitis: Skip lesions in ulcerative proctitis

Objective: To study the relationship between appendix, appendicitis and ulcerative colitis. Also to evaluate skip lesions in ulcerative proctitis. Methods: A patient with ulcerative proctitis with skip lesion in the mid-ascending colon was studied in detail. The literature on the question of appendectomy, appendicitis and ulcerative colitis was studied extensively and evaluated critically. In depth study of publications on the subject of skip lesions in the proximal colon in cases of the distal colitis was carried out. Results: The patient was a 22 year old man with ulcerative proctitis who had a skip lesion in the mid-ascending colon which is a rare occurrence. Based on the literature search and review we formulated three questions (a) Does appendectomy protect against ulcerative colitis (b) Do patients with ulcerative colitis have a lower incidence of appendicitis (c) In an established case of ulcerative colitis, does appendectomy ameliorate the severity of ulcerative colitis. The answers have been discussed in the text. The problem of skip lesion in ulcerative proctitis was also studied and addressed. Conclusions: Appendectomy performed before the age of 20 years especially if performed between 10 - 14 years of age may protect against subsequent development of ulcerative colitis. Skip lesions in the ascending colon, cecum and around the appendiceal orifice can occur in cases of ulcerative proctitis and do not negate the diagnosis of ulcerative colitis.