What should be done if the appendix appears normal during an appendectomy but Crohn's disease is present?

When encountering a situation where the appendix appears normal during an appendectomy but Crohn's disease is present, the best course of action is to take the appendix unless the cecum is involved in inflammation. This approach is based on the understanding that appendicitis can coexist with Crohn's disease and that the presence of Crohn's disease may indicate a higher likelihood of future complications resulting from the appendix.

In cases of Crohn's disease, there is a risk of undetected inflammation or disease affecting the appendix even when it appears normal. Removing the appendix can help prevent potential complications such as future appendicitis or other colonic issues associated with Crohn's. However, if the cecum is involved in the inflammatory process, leaving the appendix intact is prudent. This is because the inflammatory process may suggest a broader involvement of the bowel that could complicate the surgical procedure and management.

Therefore, the recommendation to take the appendix unless there is cecal involvement reflects a cautious balance between addressing the patient's existing Crohn's disease and preventing unnecessary complications. It emphasizes the necessity of assessing not only the appendix but the surrounding structures for any signs of inflammation.