# Painless Appendicitis: A Peculiar Surgical Case of Acute Granulomatous Appendicitis

## TL;DR

A rare case of painless granulomatous appendicitis is reported, highlighting the importance of diagnosing atypical presentations.

## Contribution

This paper presents a unique case of painless granulomatous appendicitis linked to systemic inflammation.

## Key findings

- The patient had acute retrocecal appendicitis without typical symptoms like pain.
- Histology confirmed granulomatous appendicitis, possibly linked to sarcoidosis.
- The case emphasizes the need for high suspicion in diagnosing atypical appendicitis.

## Abstract

Acute appendicitis is one of the most common surgical emergencies, typically presenting with right-sided abdominal pain, nausea, and anorexia. Painless appendicitis is very uncommon and poses a diagnostic challenge. This case report highlights an unusual presentation of painless granulomatous appendicitis. We present a female patient in her 20s with a history of erythema nodosum and systemic inflammatory symptoms who was incidentally diagnosed with acute retrocecal appendicitis on imaging. Despite radiological evidence, she denied abdominal pain or other classic symptoms. After a thorough rheumatologic evaluation, she underwent laparoscopic appendicectomy, which revealed a retrocecal, inflamed appendix. The histology report revealed granulomatous appendicitis, a condition likely linked to an underlying systemic inflammatory disorder such as sarcoidosis. Granulomatous appendicitis is a rare entity and, as it is associated with various conditions, further evaluation by the Rheumatology team is necessary. Painless appendicitis is uncommon but clinically important, and our case highlights the significance of maintaining a high suspicion index in atypical presentations to ensure timely diagnosis and management.