Colonoscopy in Acute Appendicitis

Abstract

A 46-year-old man with fluctuating abdominal pain and slight elevation of inflammatory markers (C-reactive protein 22.2 mg/L, normal <5) was referred for ileocolonoscopy after surgical evaluation including a non-diagnostic ultrasound examination. Endoscopy revealed an appendiceal orifice with profound intraluminal bulging (Picture 1A) and spontaneous purulent discharge as well as minor mucosal erythema (Picture 1B). The patient underwent an uneventful appendectomy including cecal pole resection. Final pathologic evaluation confirmed the presence of ulcero-phlegmonous appendicitis with accentuated involvement of the appendix base.The diagnosis of acute appendicitis is occasionally made by endoscopy in the presence of atypical symptoms and inconclusive imaging findings (1). In such a setting, endoscopic evaluation may help to rule out differential diagnoses, e.g. ileocecal tumors or inflammatory bowel disease (2). Endoscopic features include orificial buldging and edematous mucosal alterations. Sometimes, active putride secretion is present, potentially contributing to an attenuation of the clinical course.

Diagnóstico incidental de apendicitis aguda por colonoscopia, reporte de un caso

“…Ocasionalmente el diagnóstico puede ser precisado mediante laparoscopia exploratoria, en casos en que los exámenes descritos no fueron concluyentes o incluso mediante procedimientos endoscópicos, como fue nuestro caso. En los hallazgos endoscópicos descritos en la literatura están mencionadas las alteraciones inflamatorias de la mucosa, papila apendicular prominente y secreción purulenta por el ostium apendicular (16,17).…”

Endoscopic retrograde appendicitis therapy: a pilot minimally invasive technique (with videos)

“…[10][11][12][13] Liu et al 14 also described 1 patient with acute appendicitis treated by endoscopic drainage. However, no additional cases were reported, and temporary drainage might be not sufficient if the remaining fecalith or stenosis results in symptom recurrence.…”

Acute appendicitis diagnosed incidentally by colonoscopy in colorectal cancer screening

“…The clinical role of colonoscopic screening in the diagnosis of colorectal cancer has already been emphasized. However, several reports have lately addressed the colonoscopic diagnosis of acute appendicitis (1)(2)(3). We report an asymptomatic patient with no abnormal clinical and laboratory findings that diagnosed as acute appendicitis during colonoscopic screening.…”