Post-colonoscopy appendicitis: A case report and systematic review

Abstract

Colonoscopy is a widely used diagnostic and therapeutic modality with a relatively low morbidity. However, given the large volume of procedures performed, awareness of the infrequent complications is essential. Perforation is an established complication of colonoscopy, and can range from 0.2%-3% depending on the series, population and modality of colonoscopy. Acute appendicitis after colonoscopy is an extremely rare event, and a cause-effect relationship between the colonoscopy and the appendicitis is not well documented. In addition, awareness of this condition can aid in prompt diagnosis. Relatively mild symptoms and exclusion of bowel perforation by contrast studies do not exclude appendicitis from the differential diagnosis for post-colonoscopy pain. In addition to the difficult diagnosis inherent to postcolonoscopy appendicitis, treatment strategies have varied greatly. This paper reviews these approaches. We also expand upon prior articles by giving guidance for the role of nonoperative management in these patients. This case and review of the literature will help to create awareness about this complication, and guide optimal treatment of pericolonoscopy appendicitis.

A different type of perforation: appendicitis after colonoscopy

“…3 Other proposed mechanisms include local oedema from trauma induced by the endoscope or intervention causing temporary obstruction of the appendiceal orifice. 4 It has also been suggested that excess pressure from the endoscope at the appendiceal lumen and possible excess inflation can result in inflammation secondary to trauma or promote the formation of a faecolith. 1,5–7…”

Colonoscopy-Induced Acute Diverticulitis

“…Postcolonoscopy appendicitis should also be considered. It is such an unusual and extremely rare complicationthat causation by colonoscopy has not yet been adequately documented 11) .…”

Acute Abdominal Pain Following Optical Colonoscopy: CT Findings and Clinical Considerations

“…Although exceptionally infrequent, appendicitis can be seen as a complication of optical colonoscopy [34][35][36][37][38][39][40]. Only 28 cases of appendicitis as a complication of optical colonoscopy have been reported in the literature to our knowledge; the frequency has been estimated at 3.8 cases of appendicitis per 10,000 procedures [37,40].…”

“…Only 28 cases of appendicitis as a complication of optical colonoscopy have been reported in the literature to our knowledge; the frequency has been estimated at 3.8 cases of appendicitis per 10,000 procedures [37,40]. The pathophysiology is not well understood, but a few mechanisms have been suggested.…”

“…The pathophysiology is not well understood, but a few mechanisms have been suggested. They include barotrauma from overinsufflation, direct trauma from accidental intubation of the lumen of the appendix causing inflammation, compression of stool into the appendix that may cause obstruction or inflammation, and exacerbation of subclinical disease [1,[34][35][36][37][38][39][40]. Additionally, preexistent appendicoliths may be present that, combined with appendiceal trauma from optical colonoscopy, may predispose to appendicitis.…”