Acute appendicitis following endoscopic mucosal resection of cecal adenoma

Abstract

Endoscopic mucosal resection (EMR) allows the removal of flat or sessile lesions, laterally spreading tumors, and carcinoma of the colon or the rectum limited to the mucosa or the superficial submucosa. Acute appendicitis is the most common abdominal emergency requiring emergency surgery, and it is also a rare complication of diagnostic colonoscopy and therapeutic endoscopy, including EMR. In the case presented here, a 53-year-old female underwent colonoscopy due to a positive fecal occult blood test and was diagnosed with cecal adenoma. She was referred to our hospital and admitted for treatment. The patient had no other symptoms. EMR was performed, and 7 h after the surgery, the patient experienced right -lower abdominal pain. Laboratory tests performed the following day revealed a WBC count of 16000/mm(3), a neutrophil count of 14144/mm(3), and a C-reactive protein level of 2.20 mg/dL, indicating an inflammatory response. Computed tomography also revealed appendiceal wall thickening and swelling, so acute appendicitis following EMR was diagnosed. Antibiotics were initiated leading to total resolution of the symptoms, and the patient was discharged on the sixth post-operative day. Pathological analysis revealed a high-grade cecal tubular adenoma. Such acute appendicitis following EMR is extremely rare, and EMR of the cecum may be a rare cause of acute appendicitis.

Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis

“…Regarding the subgroup of patients with adenomas involving the appendiceal orifice this is considered to be a difficult anatomic location for endoscopic resection. There have been few reports of endoscopic resection of colon polyps involving the appendiceal orifice [31][32][33]. In patients with no prior history of appendectomy, when the deep margin into the appendiceal lumen is not well visualized, complete resection is not possible endoscopically.…”

Endoscopic submucosal dissection of cecal lesions in proximity to the appendiceal orifice

“…One of the major potential concerns of performing ESD in the region of the appendiceal orifice is the development of post-ESD appendicitis. Previous reports have described appendicitis following routine colonoscopy without intervention [24,25], as well as appendicitis after cecal interventions, such as EMR [26].…”

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]…”