Ming-Li Wang, MD, Kuldeep Singh, MD, Federick Sabido, MD. Staten Island University Hospital
Acute appendicitis is an extremely rare complication of colonoscopy. Only 13 cases of acute appendicitis after colonoscopy have been reported in the English literature. We present a case of acute appendicitis after colonoscopy and performed a literature review.
Methods and Procedures:
A 50 year old female underwent a screening colonoscopy without biopsy. On post-procedure day 2, she presented with worsening abdominal pain. A CT scan revealed an appendicolith with acute appendicitis (figure 1). A laparoscopic appendectomy revealed a non-perforated thickened appendix. Pathologic examination revealed a dilated appendix with focal acute appendicitis associated with fecal impaction.
Acute appendicitis following colonoscopy is a rare complication, with an incidence of 0.038%. Four mechanisms of post-colonoscopy appendicitis have been postulated: 1) pre-existing subclinical disease of the appendix 2) overinsufflation causing barotraumas 3) introduction of fecalith or impaction of stool into the appendix, 4) direct trauma. Vendor et al reported the few cases that occurred at two institutions where a total of 8000 colonoscopies were performed and found an incidence of about 0.038%. Although this is lower than the incidence of colonic bleeding (0.21%) or perforation (0.1%), its clinical significance should not be overlooked. In our case, we believe that the causal event was the fecalith that was introduced into the appendix by the air insufflation. This is suggested by no symptoms prior to procedure followed by the finding of impacted stool in the appendix after appendectomy.
Overall, acute appendicitis is a rare condition after colonoscopy but an important complication to consider for all patients presenting with abdominal pain after colonoscopy. In our case, the finding of impacted fecal material inside the appendix and mild appendicitis on surgery and pathology supports the notion that colonoscopy may induce appendicitis by introducing fecal material into the appendiceal lumen upon insufflation. It may prove beneficial to avoid or reduce colonoscopy induced appendicitis by irrigating the appendix during colonoscopy to reduce fecal impaction. Appendicitis must be considered in a differential diagnosis of post-colonoscopy abdominal pain.
Program Number: P205