Postcolonoscopy Appendicitis Research Articles

Post-colonoscopy appendicitis: Systematic review of current evidence.

Appendicitis after colonoscopy is an exceedingly rare complication. It remains to be explored if this entity is truly a complication of colonoscopy or a coincidental occurrence of appendicitis post-colonoscopy. The aim of this study was to systematically review all the available evidence since it was first described in 1988. The literature on post-colonoscopy appendicitis was searched using PubMed, EMBASE, and Cochrane databases. Additional manual search was performed and cross-checked for additional references. The search was performed up to November 2019. Data collected included demographics, reason for colonoscopy, time to diagnosis, imaging performed, management, and outcome. Fifty-three cases were found in the systematic review with a median age of 55years (24-84years). The time to diagnosis post-colonoscopy was mostly within 24-48h. Clinical features mimicked those of common acute appendicitis. In the past decade, computed tomography scan has been the imaging choice to investigate abdominal pain after colonoscopy, mainly to rule out perforation. The mainstay of management was appendectomy (open or laparoscopy). Four of the 12 cases (33.3%) were treated successfully with antibiotics alone. There has been a twofold increase in cases reported in the past decade (2009-2019, n=31 vs 1999-2008, n=15). There is a considerable variation in the definition of post-colonoscopy appendicitis in the current literature. Regardless of whether post-colonoscopy appendicitis is a true entity, it should be considered as a differential diagnosis in any patient presenting with acute abdomen following colonoscopy.

Postcolonoscopy Appendicitis: A Review of 57 Cases.

The purpose of this study is to review the cases of postcolonoscopy appendicitis (PCA) reported in the literature. A comprehensive search using PubMed, EMBASE, Scopus, and Google Scholar identified 57 cases. The median age at presentations of PCA was 55 years. PCAs typically occurred during the first 24 hours after colonoscopy, and the majority developed after diagnostic colonoscopy. Clinical presentations were similar to those with common acute appendicitis, though with a high perforation rate. Most patients were correctly diagnosed using ultrasound or computed tomography scan. Treatment included open appendicectomy, laparoscopic appendicectomy or cecotomy, radiologic drainage of the abscess, nonoperative treatment with antibiotics. In addition to barotrauma, fecalith impaction into the appendiceal lumen, direct trauma to the appendiceal orifice, and underlying ulcerative colitis, a pre-existing subclinical disease of the appendix seems to play an important role in the pathogenesis. For PCA, timely diagnosis and management are crucial to attain a satisfactory outcome.

Post-Colonoscopy Appendicitis: A Rare but Concerning Entity

Appendicitis following colonoscopy is an exceedingly rare event with an absolute risk of 1 per 56,000 cases. However, with the percentage of the screened population increasing, the incidence of this complication is expected to rise. Thus, maintaining a high index of suspicion during the early post-procedural period when the incidence is greatest can aid in timely diagnosis. Herein, we present a case of post-colonoscopy appendicitis in a patient who presented with diffuse abdominal pain 48 hours after colonoscopy. A 40-year-old woman underwent a colonoscopy for evaluation of anemia and a suspected occult bleed. Labs revealed Hgb 9.6 g/dL and MCV 71 fL. Following an uneventful bowel preparation, the procedure was performed without any intra-procedural complications. No polyps, diverticula, ulcers, erosions, arteriovenous malformations or masses were found. The colonoscope was advanced to the cecum without difficulty and location was confirmed by visualization of the appendiceal orifice. The patient was asymptomatic post-procedure but presented to the ED with diffuse abdominal pain and rebound tenderness 2 days later. CT abdomen with IV contrast revealed acute appendicitis with appendicoliths measuring up to 15 mm, a fluid-filled lumen, and multiple foci of gas (Image 1). The patient subsequently underwent laparoscopic appendectomy with biopsy results confirming acute gangrenous appendicitis. An estimated 15 million colonoscopies were performed in 2012. Coupled with a 2014 national campaign to promote colorectal cancer screening, we expect the number of colonoscopies and the incidence of their complications to rise significantly. One such complication is appendicitis, which has been shown to be at least 4 times more likely in the first week following colonoscopy. Proposed mechanisms for post-colonoscopy appendicitis include advancement of fecal material into the appendiceal lumen, changes in gut microbiota after bowel preparation, over-insufflation, intubation of the appendiceal lumen, and exacerbation of pre-existing subclinical disease. In our patient, the gas pattern was highly unusual with gas evidenced both proximal and distal to the appendicolith (Image 2), which was suggestive of local disruption. In the absence of preceding local disease, a suggestive temporal relationship, and radiologic evidence of local disruption, colonoscopy was most likely the etiology for her appendicitis.1548_A Figure 1 No Caption available.1548_B Figure 2 No Caption available.

An unusual cause of acute abdomen: Post-colonoscopy appendicitis.

Colonoscopy is commonly performed for diagnostic and therapeutic purposes and has a relatively low morbidity rate. Nevertheless, it is necessary for operators to be aware of the rare complications of colonoscopy due to a large number of procedures performed in daily practice. Acute appendicitis is an unusually rare occurrence after colonoscopy, with no clear association being found between the colonoscopy and acute appendicitis. A rapid diagnosis of this complication is possible by widespread awareness in surgeons regarding this condition. Acute appendicitis cannot be reliably resulted in as the cause of acute abdominal pain due to relatively subtle signs, symptoms, and studies performed for bowel perforation. The diagnosis of postcolonoscopy appendicitis is difficult, and strategies for its treatment show significant variation. This report presents a patient having undergone urgent laparotomy within 12 h after colonoscopy on having signs and symptoms of acute appendicitis-induced peritonitis.

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

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.

Acute Appendicitis Following Colonoscopy

Background: Acute appendicitis after colonoscopy is a rare sequela and may be incidental or a true complication of colonoscopy. This review explores the cause and effect relationships between colonoscopy and the development of acute appendicitis. Methods: We conducted a systematic review of the literature to identify articles up to July 2011. The following time intervals were collated from documented cases to evaluate the natural history of postcolonoscopy appendicitis: time from colonoscopy to symptom onset, time from symptom onset to presentation (preadmission delay), and time from symptom onset to surgery. Postadmission delay was then estimated. Discussion: Paucity of published cases on postcolonoscopy appendicitis may be the result of acute appendicitis being incidental after colonoscopy or because of under-recognition of this complication. The close association between colonoscopy and the onset of symptoms of acute appendicitis suggests a relationship between the procedure and pathology. However, at present, the data available are inadequate to give firm details on the natural history of acute appendicitis after colonoscopy. Shared symptomatology and examination findings between postcolonoscopy appendicitis and common colonoscopic complications such as colonic perforation and postpolypectomy syndrome result in delayed diagnosis. Our findings suggest that delayed surgical intervention is associated with increased morbidity and mortality and is clinician dependent in a majority of cases. Conclusion: Regardless of whether postcolonoscopy appendicitis represents an incidental finding or true complication of colonoscopy, consideration of acute appendicitis as a differential diagnosis of the acute abdomen after colonoscopy is important.

Post-colonoscopy Appendicitis and Small Bowel Obstruction

Introduction: Colonoscopy is a common procedure used for screening, diagnosis, and treatment of gastrointestinal disease. Life threatening complications are uncommon, but include perforation, hemorrhage, diverticulitis and postpolypectomy syndrome. Although previously reported, the association between appendicitis and colonoscopy is not widely known. There may be a underreported association between colonoscopy and appendicitis with literature-based estimates as high as 3.8 appendicitis cases per 10,000 procedures. We present a case of appendicitis with small bowel obstruction presenting two days after screening colonoscopy. Case: A 66-year-old female with PMH HTN presents to the ER 2 days after screening colonoscopy for worsening diffuse abdominal pain worse with movement. Pt had abd series done which showed mild enlarged loops of bowel and CT abd with po/iv contrast showed findings consistent with perforated appendicitis with several periappendiceal fluid collections as well as generalized ileus vs distal small bowel obstruction. Pt was monitored and managed conservatively with IV hydration, antibiotics and electrolyte replacement for five days. Pt continued to have RLQ tenderness and repeat CT showed a newly formed periappendiceal abscess with air, which was then drained by interventional radiology. Pt did well and was discharged on PO antibiotics. Discussion: We identified less than 30 cases of post-colonoscopy appendicitis reported in the literature. None of these reported cases had small bowel obstruction on presentation as well as appendicitis. Multiple theories support biologic plausibility of causality including fecalith impaction into the appendiceal lumen and/or direct appendiceal trauma by gas insufflation or direct instrumentation and appendiceal trauma, all of which could conceivably cause appendicitis or exacerbate previous subclinical disease. Timely diagnosis is important as this is a life-threatening complication.Figure

Post-colonoscopy appendicitis: A case report and systematic review

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.

Post-colonoscopy Appendicitis in Ulcerative Colitis: Chance or Causality

Post-colonoscopy Appendicitis in Ulcerative Colitis: Chance or Causality

Post-Colonoscopy Appendicitis: A Rare Complication of Colonoscopy

Post-Colonoscopy Appendicitis: A Rare Complication of Colonoscopy

An unusual cause of postcolonoscopy abdominal pain

Colonoscopy is a common procedure used for screening, diagnosis, and treatment of gastrointestinal disease. Life-threatening complications are uncommon (28/10 000 procedures) but include perforation, hemorrhage, diverticulitis, and postpolypectomy syndrome. Although previously reported, the association between appendicitis and colonoscopy is not widely known. This case report highlights the underlying pathophysiology, clinical presentation, and diagnosis of postcolonoscopy appendicitis. A 52-year-old man presented to the emergency department with abdominal pain 8 hours after an uncomplicated routine screening colonoscopy. He initially reported mild generalized abdominal discomfort which 3 hours after the procedure intensified and localized to the periumbilical region. Computed tomography of the abdomen with oral and intravenous contrast revealed appendicitis as the cause of his abdominal pain. He underwent laparoscopic appendectomy and recovered uneventfully. Colonoscopy is a common procedure that rarely has life-threatening complications. Although establishing causality is difficult, there is an association between colonoscopy and appendicitis, which may be underreported with literature-based estimates as high as 3.8 appendicitis cases per 10 000 procedures. Timely diagnosis of postcolonoscopy appendicitis may prove challenging given limited knowledge of this association between colonoscopy and appendicitis and similarity of presentation with other more well-known complications. This case report demonstrates that a recent history of colonoscopy should not preclude consideration of a traditionally broad differential diagnosis for abdominal pain, including appendicitis.

Postcolonoscopy Appendicitis

Outpatient colonoscopy has been proven safe but can rarely be associated with serious complications. The addition of polypectomy to the procedure increases the incidence of all complications with hemorrhage accounting for approximately half. The use of electrocautery for hot biopsy or polyp removal can result in a full-thickness burn without perforation in approximately 1 per cent of cases and typically presents as focal peritonitis without pneumoperitoneum. This so-called "postpolypectomy syndrome" or "serositis" is often successfully managed medically with resolution of symptoms in 24 to 48 hours. Bowel perforation occurs in less than 1 per cent of patients but requires emergent laparotomy. Appendicitis, both acute and perforated, has been reported as a rare complication of colonoscopy.

Postcolonoscopy appendicitis in a patient with active ulcerative colitis

Complications due to diagnostic colonoscopy are uncommon and acute appendicitis is a very rare complication of colonoscopy. This poses a diagnostic challenge as the presentation of appendicitis is similar to that of other complications of colonoscopy such as perforation or postpolypectomy syndrome. It is hypothesized that postcolonoscopy appendicitis might be associated with obstruction of the appendiceal lumen with fecal matter during colonoscopy. None of the previous reports in the literature have described findings of appendicitis after colonoscopy in a patient with active ulcerative colitis. We present a case of a 28 year-old man with active ulcerative colitis who underwent colonoscopy and subsequently developed acute appendicitis.

An unusual complication: postcolonoscopy appendicitis

An unusual complication: postcolonoscopy appendicitis

Postcolonoscopy Appendicitis: Case Report and Review of the Literature

Izzedine, Hassane M.D.; Thauvin, Hughes M.D.; Maisel, Andre SurgD.; Bourry, Edward M.D.; Deschamps, Anna M.D. Author Information