Relationship between the appendix and ulcerative colitis: A new discovery

Figure 1 Endoscopic findings throughout the colon: Pyogenic lesion at appendiceal orifice and distal inflammation. A: Appendiceal orifice. Pyogenic legion with a mosslike appearance attached to the appendiceal orifice, and the lesion was accompanied by peri-appendicular red patches; B: Ascending colon, mucosa appeared normal; C: Transverse colon, mucosa appeared normal; D: Descending colon, mucosa appeared normal; E: Sigmoid colon, erythematous and erosion with attached inflammatory secretions endoscopically; F: Rectum, erythematous and erosion with attached inflammatory secretions endoscopically.

Figure 2 Endoscopic appearance of suppurative appendicitis: Characteristic inflammatory changes from orifice to blind end. A: Appendiceal orifice; B: Proximal appendiceal lumen; C: Mucosal biopsy; D: Middle part of appendiceal lumen; E and F: Blind end of appendix. Appendiceal mucosa showing diffuse edema, hyperemia, erosion, and a large number of purulent secretions.

Figure 3 Histopathological diagnosis of ulcerative colitis across multiple colonic sites. A: Appendix; B: Ileocecal region; C: Sigmoid colon; D: Rectum. The pathological findings of appendiceal, ileocecal, sigmoid, and rectal mucosal biopsies were consistent with ulcerative changes: Uneven distribution of crypts, crypt distortion, visible cryptitis, focal crypt loss, massive plasma cell and lymphocyte infiltration in the stroma, and focal neutrophil infiltration.

Figure 4 Endoscopic contrast: Normal proximal colon vs healed ulcer scars in the distal colon. A: Appendiceal orifice, normal appendiceal orifice and surrounding mucosa; B: Ascending colon, mucosa appeared normal; C: Transverse colon, mucosa appeared normal; D: Descending colon, mucosa appeared normal; E: The sigmoid colon mucosa showed ulcer scars, indicating healing; F: The rectal mucosa similarly exhibited ulcer scars, consistent with mucosal healing.