Acute Appendicitis Caused by Colonoscopy

Abstract

A 48-year-old woman who was without any abnormal past medical history underwent colonoscopy as a screening procedure for colorectal disease. The procedure was uneventful and there was no sign of inflammation around the appendicular orifice or the luminal surface of the cecum. The patient did not complain of pain or significant discomfort throughout the procedure. She then developed pain in the right lower quadrant of the abdomen that evening and this persisted for four days. She visited the outpatient department and underwent abdominal ultrasonography, which showed a swollen appendix with a collection of pericecal fluid. Surgical exploration and appendectomy were performed; the final diagnosis was acute suppurative appendicitis. Colonoscopists should be aware of this rare complication and consider it when making the differential diagnosis of post-colonoscopy abdominal pain.

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

“…Acute appendicitis following colonoscopy is a rare complication, with a considered incidence of 0.038% [7], according to a research of 2007, either because of underpublication or underrecognition due to simultaneous conservative treatment.…”

“…An electronic literature search was performed on MEDLINE and manual retrieval of the reference lists of selected papers completed the research. A total of 31 articles were identified in the literature, with a total of 37 cases of postcolonoscopy appendicitis [5, 7–36]. The basic characteristics of these cases, including our own case, are included in Table 1.…”

Complications of Optical Colonoscopy

“…17 and 18), edema from mucosal trauma around the cecum, perforation at cecal biopsy sites, and barotrauma. 30 Chemical colitis involving part or all of the colon may develop after colonoscopy if the glutaraldehyde and/or hydrogen peroxide solutions used during disinfection have not been adequately rinsed from the colonoscope. 31 These agents induce ischemic effects on the mucosa and, on occasion, deeper layers of the colon wall (Figs.…”

Diagnostic Challenges in Acute Appendicitis

“…One should bear in mind that as the vermiform appendix can end up in the left side of the abdomen as a result of midgut malrotation, dextrocardia may not always be present. Chae et al (2007) report a case of a 49 year old lady who underwent a colonoscopy as part of a bowel screening programme. The colonoscopy was uneventful and all caecal landmarks were identified.…”