Colonoscopic Appearances of an Appendiceal Remnant: The Benign Masquerading as the Sinister

Abstract

A 50-year-old woman presented with a 3-month history of alternating diarrhea and constipation, with no associated weight loss. Her only medical history was that of an emergency appendectomy 33 years ago. The patient's blood investigations and stool samples were unremarkable. Her family physician organized a virtual colonoscopy to investigate any underlying pathology. Imaging revealed a heterogeneous mass in the cecum along with several small nonpathological nodes along the draining vascular chain (Figure 1). She subsequently underwent an urgent colonoscopy which revealed a 5-cm pedunculated polyp (Paris 1p) at the cecal pole (Figure 2). Image-enhanced endoscopy revealed round pits and the absence of meshed capillary vessels (Kudo I) (Figure 3). Biopsies revealed fragments of large bowel mucosa with a diffuse increase in chronic inflammatory cells in the lamina propria and reactive lymphoid follicle. The radiological and endoscopic findings were in keeping with an inverted appendiceal remnant.