Diagnostic Colonoscopy Leading to Perforated Appendicitis: A Case Report and Systematic Literature Review

Abstract

Introduction. Intestinal perforation is a known complication after colonoscopy. However, appendiceal involvement with inflammation and perforation is extremely rare and only 37 cases of postcolonoscopy appendicitis have been reported so far. We describe a case of perforated appendicitis 24 hours after colonoscopy that was treated successfully in our Department. Case Report. A 60-year-old female patient underwent a colonoscopy during the investigation of nontypical abdominal pain without pathologic findings. 24 hours after the examination she presented gradually increased right lower quadrant abdominal pain and a CT scan was performed, showing an inflammation of the appendiceal area with free peritoneal air. Through laparotomy, perforated appendicitis was diagnosed and an appendectomy was performed. The patient was discharged on the tenth postoperative day in good health condition. Discussion. The characteristics of all cases reported in the literature are described, including our case. Perforated appendicitis soon after a colonoscopy is a rare, but serious complication; therefore, it is crucial to be included in the differential diagnosis of postcolonoscopy acute abdominal pain.

Postcolonoscopy acute appendicitis - our case series and a review of the literature

“…The mechanism of developing appendiceal inflammation is rather unknown, than theoretical assumptions. However, acute appendicitis should be considered in the differential diagnosis of a post-colonoscopy abdominal pain, in order to avoid a delayed diagnosis and complications such as perforation of the appendix 21,22 and peritonitis. The clinical awareness of post-colonoscopy appendicitis must be increased.…”

Perforated appendicitis after colonoscopy

“…As we know, the total reported case number with perforated appendicitis after colonoscopy is 14 by now. [ 9 ] All of these cases had presented symptoms from immediate to 27 hours after the colonoscopy. These cases aged from 45 to 79 years old (average age was 56.9 years old).…”

“…The mechanisms by which colonoscopy results in appendicitis remain unclear, but several hypotheses have been proposed, including: preexisting subclinical disease of the appendix, [ 6 , 9 – 11 ] barotrauma as a result of overinsufflation, [ 6 , 7 , 9 – 11 ] introduction of a fecalith into the appendix, leading to obstruction or inflammation, [ 6 – 11 ] edema caused by direct intubation of the appendiceal lumen, [ 6 , 7 , 9 – 14 ] and exposure of the mucosa to the residual glutaraldehyde-type solution used in cleaning the endoscope, leading to inflammation. [ 6 , 10 , 11 ]…”

“…However, the possibility of the presence of fecaliths in the lumen of the appendix prior to the colonoscopy could not be entirely excluded. [ 9 ] Another possible reason for the appendiceal perforation is barotrauma due to overinsufflation from the endoscope. Because preoperative CT showed a typical sign of colonic perforation with free pneumoperitoneum.…”

Non-Ionizing Label-Free Photoacoustic Imaging of Bones

“…Significant technical advances have led to a variety of systems for real-time high-resolution 2D radiography and 3D computed tomography (CT) [4,5]. X-ray radiographs are used to diagnose maladies in almost any part of the body, including the chest (heart and lung), abdomen, spine, brain, teeth, and pediatric growth plates (bone age), and to image and monitor conditions such as sinusitis and fractures [6][7][8][9][10][11][12]. Xray imaging provides particularly high image contrast for organic and inorganic hard target materials, such as bones and metals.…”