An inverted appendix found on routine colonoscopy: A case report with discussion of imaging findings

Abstract

Appendiceal inversion is an uncommon incidental finding on colonoscopy that can mimic pathologic processes such as colon polyps and neoplasms due to its mass-like appearance. Endoscopic removal of these lesions has been associated with a higher risk of peritonitis and bleeding. Awareness of appendiceal inversion may potentially decrease unwarranted interventions as well as its associated risks. Although there are many reported cases of iatrogenic appendiceal inversion due to the traditional inversion-ligation technique performed during open appendectomy, there are few reported cases of asymptomatic appendiceal inversion without a known history of iatrogenic inversion. Here, we present a case of an asymptomatic patient with appendiceal inversion and no prior history of appendectomy. Furthermore, we discuss management and characteristic imaging findings of appendiceal inversion that may help to distinguish it from similarly appearing pathologic conditions.

Incidental Finding of an Inverted Appendix

“…Inversion is usually asymptomatic but can present as acute appendicitis or intussusception resulting in abdominal pain, hematochezia, vomiting, diarrhea, or constipation (3). It is thought that the inversion of the appendix may result from appendix peristalsis due to local inflammation or by appendix endometriosis (4). Endoscopic removal of inverted appendix, when symptomatic can be achieved safely through endoloop ligation followed by distal snare polypectomy (5) whereas, if asymptomatic, conservative management with observation has been proposed (6).…”

Inverted Appendix in a Patient With Weakness and Occult Bleeding

“…6 Other causes of appendiceal inversion include intussusception, acute appendicitis, appendiceal nodule, or even iatrogenic due to appendectomy. [12][13][14] While appendiceal inversion can be completely benign, because these morphological changes of the appendix can resemble a polyp, these lesions are often biopsied and/or resected. 15 However, lesion resection may be quite problematic due to high risk of bleeding and perforation.…”

Colonoscopic Appearances of an Appendiceal Remnant: The Benign Masquerading as the Sinister

“…Appendiceal remnants are an unusual finding both endoscopically and radiologically and can be mistaken for pathological processes such as polyps or malignant lesions. 1 They most often occur because of intussusception or postappendectomy through the inversion-ligation method. 1 In this approach, the appendix base is initially ligated, then cut.…”

“… 1 They most often occur because of intussusception or postappendectomy through the inversion-ligation method. 1 In this approach, the appendix base is initially ligated, then cut. The appendiceal stump is subsequently inverted into the lumen of the cecum, and a purse-string suture is tied to close.…”