The iatrogenic caecal polyp: can it be avoided?

Abstract

A 60-year-old farmer was admitted with symptoms and signs suggestive of appendicitis. The diagnosis was confirmed at open appendicectomy where the appendix base was ligated and inverted into the caecum with a purse-string suture. Following an uneventful recovery and discharge, a barium enema identified a 2 cm filling defect in the caecal pole. A subsequent colonoscopy revealed only a tiny sessile polyp in the caecum with histology demonstrating normal colonic mucosa. This case report discusses the rare occurrence of an inverted appendix stump mimicking caecal pathology and the rationale of post-appendicectomy colonic investigation in the elderly patient.

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

“…The appendiceal stump is subsequently inverted into the lumen of the cecum, and a purse-string suture is tied to close. 2 This technique was commonly performed by surgeons to theoretically reduce the risk of peritoneal contamination in the setting of acute appendicitis. The inverted appendiceal stump usually necroses if the vascular supply is adequately occluded during suturing and sloughs away after several days.…”

Inverted appendix in a patient with colon cancer: a case report and long-term follow-up

“…Iatrogenic inversion is done during open surgeries for appendicitis or malrotation and historically in normal appendixes to theoretically avoid future peritoneal contamination in cases of inflammation [ 4 ]. This is not done in laparoscopic surgery [ 5 ].…”

An inverted appendix found on routine colonoscopy: A case report with discussion of imaging findings

“…The most common iatrogenic cause of AI occurs during open appendectomy when the base of the appendix is inverted into the cecum with a purse-string suture, a technique that is not used during laparoscopic appendectomy [2]. A series of 395 colonoscopies of patients with a history of open appendectomy found an oblong mass-like lesion corresponding to an inverted appendix in 6 of the patients [3].…”