Laparoscopic management of necrotizing granulomatous appendicitis: a diagnostic challenge

We present a case report of necrotizing granulomatous appendicitis, a rare condition that poses significant diagnostic challenges due to its atypical presentation, often mimicking more common conditions like acute appendicitis or inflammatory bowel disease. A 29-year-old female was admitted with a one-month history of abdominal pain, diarrhea, vomiting, and recent urinary symptoms. Laboratory tests revealed leukocytosis, elevated C-reactive protein, and anemia. A CT scan indicated an inflamed appendix, prompting a laparoscopic appendectomy. Intraoperatively, findings raised the suspicion of inflammatory bowel disease; however, histopathological analysis confirmed necrotizing granulomatous appendicitis. Further microbiological testing excluded bacterial and fungal infections, while the IGRA test was positive for tuberculosis. This case emphasizes the dual role of laparoscopic surgery in both diagnosing and treating necrotizing granulomatous appendicitis. It highlights the importance of considering rare etiologies, such as tuberculosis, especially in patients presenting with atypical symptoms. Early recognition and appropriate management are crucial for improving patient outcomes.