Post-Colonoscopy Appendicitis: A Rare Entity

Abstract

A 35-year-old woman was admitted to the surgical ward complaining of right-sided lower abdominal pain. She had undergone colonoscopy a week previously. She was diagnosed with acute appendicitis following colonoscopy and laparoscopic appendectomy was performed via the 2-port technique. Post colonoscopy appendicitis is very rare with 14 cases reported since 1988.

Post‐colonoscopy appendicitis: Systematic review of current evidence

“…All the cases are summarized in Table 1. [4][5][6][7][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]30,[32][33][34][35][36][38][39][40][41][42][43][44][45][46][47][48]…”

“…Twenty‐nine patients required appendectomy (seven cases by laparoscopy); two were managed successfully with intravenous antibiotics. All the cases are summarized in Table 1 4–7,9–28,30,32–36,38–48 …”

“…Other imaging options such as plain radiographs and ultrasound did not appear to assist in further management. 4,6,12,16,22,24,27,28,33,39,43,44 The diagnosis of appendicitis was established during colonoscopy in three cases. [51][52][53] Characteristically, the endoscopic findings of these cases demonstrated pus exudating from the appendiceal orifice.…”

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].…”

“…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.…”