Post-colonoscopy appendicitis: a case report

Abstract

Appendicitis after colonoscopy is rare, with an estimated incidence of 3.8 cases per 10 000 colonoscopies. Herein, we report a 56-year-old female who visited the emergency department with a history of diffuse abdominal pain and nausea 8 h after a screening colonoscopy. Abdominal examination disclosed deep tenderness at Mc Burney point and positive Rovsign’s sign. Laboratory studies revealed elevated white blood cells and neutrophils (WBC 15.37 K/Ul and NEUT 86.5%) with normal C-reactive protein (5 mg/l). The initial diagnosis was acute appendicitis, which was confirmed by the ultrasonographic findings. The patient was admitted to the surgical department, and a laparoscopic appendectomy was performed. Post-colonoscopy appendicitis is increasingly recognized as a complication after colonoscopy in the last decade. Early recognition is vital in preventing morbidity and mortality. It may also be worthwhile to include appendicitis after colonoscopy as a possible complication during the consent before the procedure.

Acute perforated appendicitis after colonoscopy. A case of a rare clinical entity

“…However, rare complications such as bleeding, perforation, and post-polypectomy syndrome can occur. PCA is an extremely rare complication, first described by Houghton and Ashton in 1988, and it is generally underdiagnosed [1][2][3][4][5] . Shaw et al defined PCA as appendicitis diagnosed by standard criteria with symptoms beginning after the procedure, but within 72 hours of the colonoscopy and in the absence of any endoscopic evidence of appendicitis or cecal inflammation at the time of the initial procedure 6 .…”

“…Several etiopathogenic mechanisms have been proposed, such as barotrauma secondary to insufflation or poor bowel preparations before colonoscopy, which can precipitate ischemia or alter the microbiome, however the pathophysiology remains unclear [1][2][3][4][5][6][7][8] . Bowel preparation was excellent in our case (Boston 9) and no macroscopic feces were identified in the surgical specimen, so barotrauma is the most probable etiopathogenesis.…”

“…Patients typically experience right lower quadrant pain or diffuse abdominal pain with or without related symptoms such as nausea, vomiting, and fever. On physical examination, the findings of fever and tachycardia should raise suspicions of abdominal sepsis 3 .…”

“…Colonoscopy is the gold standard test for the diagnosis of diseases of the colon, such as inflammatory bowel disease or colorectal cancer, and its clinical applications have increased significantly in recent years [1][2][3][4] .…”

“…Post colonoscopy appendicitis (PCA) is extremely rare, with a reported incidence of 0.038%. Today it has become more recognizable and physicians should be aware that appendicitis is a possible complication of colonoscopy [1][2][3][4] . Here we describe the case of a 75-year-old patient who developed PCA and was treated using laparoscopic surgery, which is the method of choice.…”