1881 Incidental Finding of an Inverted Appendix in an Asymptomatic Patient With No Surgical History

Abstract

INTRODUCTION: An inverted appendix is a rare colonoscopic finding that typically occurs in patients who have undergone an inversion-ligation appendectomy or developed an appendiceal intussusception. There are very few cases of patients with an inverted appendix of unknown etiology reported in the literature. We report a case of an inverted appendix that was incidentally found during colonoscopy in an asymptomatic patient without intussusception or previous appendectomy. CASE DESCRIPTION/METHODS: A 66-year-old male with a history of essential hypertension, stage IV chronic kidney disease and atrial fibrillation was referred for a colonoscopy for colorectal cancer screening. He denied any abdominal pain, nausea, vomiting, melena, hematochezia, or other active complaints on initial examination. He has no known surgical history and denies family history of colorectal cancer. Colonoscopy was performed and showed a bulbous-appearing mass protruding into the lumen of the cecum. Examination of the lesion under narrow band imaging revealed normal mucosa. The rest of the exam was unremarkable. Several endoscopists reviewed the imaging of the bulbous-appearing caecal mass, and given the location and appearance of this abnormality, a clinical diagnosis of an inverted appendix was made. Further radiological confirmation with contrast imaging was deferred given the patient’s renal failure. The patient was advised to follow up if any new symptoms developed. DISCUSSION: Appendiceal inversion is a unique colonoscopic finding which can mimic other more commonly observed polypoid lesions. Over the past years, only a few cases have been reported in the literature, with even fewer cases limited to patients without history of prior appendectomy, known cystic fibrosis or endometriosis, or evidence of intussusception. As such, the diagnostic features and treatment measures may vary among cases. This case should serve as a reminder to endoscopists to remain aware of such unique anatomic variants and to accurately differentiate these from other more concerning lesions.