Appendicitis as a complication of colonoscopy

Post-colonoscopy appendicitis: A systematic review

Post-colonoscopy appendicitis is an infrequent complication of colonoscopy. This systematic review aimed to summarize the literature's current notions, clinical features, and management of post-colonoscopy appendicitis. PubMed and Embase were searched from inception until December 31, 2023. Two reviewers independently screened titles/abstracts and full-text papers for any study design about post-colonoscopy appendicitis and abstracted data. 56 articles with a total of 67 patients were included in the systematic review. The median age was 54.9 years (range 24-84), with more male individuals affected (64.2 %). The main indication of colonoscopy was investigation (37.3 %). Forty-three patients had colonoscopy with additional procedures (64.2 %). Most patients (79.1 %) presented with symptoms within two days after the colonoscopy. The clinical manifestation was the same as acute appendicitis. The diagnosis of post-colonoscopy appendicitis was confirmed in 70.2 % of the cases, mainly with abdominal computed tomography or, alternatively, ultrasound. Most patients were successfully treated with surgery (88.1 %), either open (56.8 %) or laparoscopic appendectomy (31.3 %). The conversion rate of laparoscopic appendectomy was 19.2 %. Non-operative management with intravenous antibiotics was attempted in 17 patients with a success rate of 41.2 %. Histopathology revealed acute appendicitis in 30 cases (44.8 %) and complicated appendicitis in 29 (49.2 %). Fecalith was found in 21 cases (31.3 %). Post-colonoscopy appendicitis is an infrequent but potential complication of colonoscopy. The onset of symptoms, especially pain, fever, nausea, and vomiting after a colonoscopy, should raise suspicion of this entity. A satisfactory outcome depends on timely diagnosis and appropriate management.

Post-colonoscopy appendicitis: Systematic review of current evidence

BACKGROUND AND AIM

Appendicitis after colonoscopy is an exceedingly rare complication. It remains to be explored if this entity is truly a complication of colonoscopy or a coincidental occurrence of appendicitis post-colonoscopy. The aim of this study was to systematically review all the available evidence since it was first described in 1988.

METHODS

The literature on post-colonoscopy appendicitis was searched using PubMed, EMBASE, and Cochrane databases. Additional manual search was performed and cross-checked for additional references. The search was performed up to November 2019. Data collected included demographics, reason for colonoscopy, time to diagnosis, imaging performed, management, and outcome.

RESULTS

Fifty-three cases were found in the systematic review with a median age of 55 years (24-84 years). The time to diagnosis post-colonoscopy was mostly within 24-48 h. Clinical features mimicked those of common acute appendicitis. In the past decade, computed tomography scan has been the imaging choice to investigate abdominal pain after colonoscopy, mainly to rule out perforation. The mainstay of management was appendectomy (open or laparoscopy). Four of the 12 cases (33.3%) were treated successfully with antibiotics alone. There has been a twofold increase in cases reported in the past decade (2009-2019, n = 31 vs 1999-2008, n = 15).

CONCLUSION

There is a considerable variation in the definition of post-colonoscopy appendicitis in the current literature. Regardless of whether post-colonoscopy appendicitis is a true entity, it should be considered as a differential diagnosis in any patient presenting with acute abdomen following colonoscopy.

Postcolonoscopy Appendicitis: A Review of 57 Cases

The purpose of this study is to review the cases of postcolonoscopy appendicitis (PCA) reported in the literature. A comprehensive search using PubMed, EMBASE, Scopus, and Google Scholar identified 57 cases. The median age at presentations of PCA was 55 years. PCAs typically occurred during the first 24 hours after colonoscopy, and the majority developed after diagnostic colonoscopy. Clinical presentations were similar to those with common acute appendicitis, though with a high perforation rate. Most patients were correctly diagnosed using ultrasound or computed tomography scan. Treatment included open appendicectomy, laparoscopic appendicectomy or cecotomy, radiologic drainage of the abscess, nonoperative treatment with antibiotics. In addition to barotrauma, fecalith impaction into the appendiceal lumen, direct trauma to the appendiceal orifice, and underlying ulcerative colitis, a pre-existing subclinical disease of the appendix seems to play an important role in the pathogenesis. For PCA, timely diagnosis and management are crucial to attain a satisfactory outcome.

Perforated appendicitis after colonoscopy: cause or coincidence?: A rare case report and literature review

RATIONALE

Colonoscopy is a relatively safe and common procedure with low risks of complications, and acute appendicitis with perforation is an extremely rare complication of colonoscopy. The current study presents an unusual case of acute gangrenous appendicitis with perforation following a screening colonoscopy.

PATIENT CONCERNS

A 73-year-old man presented to our emergency department with lower right abdominal pain 3 days after a routine screening colonoscopy. On physical examination the patient had signs of generalized peritonitis. Abdominal and pelvic computed tomography (CT) revealed the presence of multiple free gas in the right subphrenic space and abdominal cavity with exudate effusions in both sides of the paracolic sulci and the pelvic cavity, especially around the ascending colon and caecum. The CT scan also showed a dilated and inflamed appendix with fecaliths.

DIAGNOSES

The patient was diagnosed with acute gangrenous appendicitis with perforation after colonoscopy.

INTERVENTIONS

The patient underwent emergency exploratory laparotomy. Intraoperative findings revealed an inflamed gangrenous appendix with focal perforation and impacted fecaliths. The colon showed no evidence of perforation or other areas of concern and thus, a conclusive diagnosis was achieved. An appendectomy was performed and the abdominal cavity was rinsed and drained thoroughly.

OUTCOMES

The postoperative course was uneventful.

LESSONS

This study may increase clinical awareness with regard to perforated appendicitis after colonoscopy. Acute appendicitis should be included in the differential diagnosis of lower right abdominal pain following a colonoscopy, in addition to possible colonic injury. Furthermore, emergency surgery should be recommended for the typical signs of perforation with peritonitis and free pneumoperitoneum. Early recognition and prompt surgical treatment are critical, which can avoid severe outcomes and improve the prognosis.