Appendicitis

Abstract

Purpose: Case: A 60 yo man presented with 2 days of abdominal pain post-screening colonoscopy. Patient was asymptomatic and in good health prior to the procedure. He denied any prior surgical history. The colonoscopy exam demonstrated sigmoid diverticula and 3 descending colon polyps. These polyps were removed by snare polypectomy. One day after the colonoscopy exam, he complained of diffuse abdominal pain that eventually localized to right lower quadrant (RLQ). He also complained of fever and anorexia, without nausea or vomiting. He had passed flatus but reported no bowel movements, since the colonoscopy procedure. Upon examination, he was febrile to 101F, with a heart rate of 104 beats/minute. The remainder of the vitals was normal. Cardiac exam confirmed sinus tachycardia; abdominal exam was significant for tenderness in the RLQ with rebound tenderness. Laboratory evaluation was significant for leukocytosis of 17,000. Abdominal x-ray did not reveal free air. CT of the abdomen/pelvis revealed acute appendicitis. A surgical consult was obtained. Intraoperative findings included a contained perforated appendix with appendiceal abscess and terminal ileum obstruction. 40 cm of terminal ileum was removed along with the appendix. Patient had an unremarkable postoperative course. Discussion: The overall complication rate with screening colonoscopy is less than 1%. Appendicitis is a rare, but known complication associated with colonoscopy. To the best of our knowledge, there have only been 10 such reported cases in the English language medical literature. Although the exact mechanism is unknown; excess pressure from the endoscope, excessive air insufflation/ barotrauma or impaction of stool; have all been proposed as possible injury mechanisms to the appendiceal orifice. Early recognition of this uncommon complication is imperative in order to expedite surgical intervention and ensure a good clinical outcome.Figure