Clinics and Practice 2012; volume 2:e55

Post-colonoscopy appendicitis: McBurney’s point. Blood pressure was 110/80 mmHg, pulse rate 90/min, and body tempera- Correspondence: Vipul Yagnik, 77 Siddhraj a rare entity ture 37°C. Laboratory data showed a white cell Nagar, Rajmahal Road, Patan-384265, Gujarat, count of 11¥9/L with left shift. Alvarado score India. E-mail: [email protected] 1 2 Vipul D. Yagnik, Bhargav D. Yagnik was 8. An ultrasound scan of the abdomen Key words: appendicitis, colonoscopy. 1Ronak Endo-Laparoscopy and General revealed a non-compressible, blind ended Surgical Hospital, Patan; tubular structure measuring 10 mm in diame- Conflict of interests: the authors declare no 2GP, Ahmedabad, Gujarat, India ter in the right iliac fossa (Figure 1). A laparo- potential conflict of interests. scopic appendectomy was performed. During laparoscopy, the appendix was found to be Received for publication: 14 February 2012. inflamed in a retrocecal position. Appende - Revision received: 1 March 2012. Accepted for publication: 2 April 2012. Abstract ctomy was performed via the 2-port technique. Histopathological examination confirmed the This work is licensed under a Creative Commons A 35-year-old woman was admitted to the diagnosis of acute appendicitis. Her post-oper- Attribution NonCommercial 3.0 License (CC BY- surgical ward complaining of right-sided lower ative course was unremarkable. NC 3.0). abdominal pain. She had undergone colonoscopy a week previously. She was diag- ©Copyright V.D. Yagnik et al., 2012 Licensee PAGEPress, Italy nosed with acute appendicitis following Clinics and Practice 2012; 2:e55 colonoscopy and laparoscopic appendectomy Discussion doi:10.4081/cp.2012.e55 was performed via the 2-port technique. Post colonoscopy appendicitis is very rare with 14 Colonoscopy is a relatively safe procedure. cases reported since 1988. However, complications and adverse effects still occur, although with low frequency. Complications may be related to either bowel preparation or intubation. Complications relat- only Introduction ed to bowel preparation are aspiration, vomit- ing and acute renal failure. Common complica- Colonoscopy is commonly performed by gas- tions associated with intubation or extubation troenterologists and surgeons. Colonoscopy is are perforation and bleeding. Waye et al.use1 and the gold standard test for the diagnosis of Kavic and Basson2 listed the rare complica- colonic diseases. The most common indication tions of colonoscopy. They include mesenteric for colonoscopy in the United States in patients ischemia, cholecystitis, pancreatitis, appen- under the age of 50 years is rectal bleeding fol- dicitis,3-8 small bowel perforation, volvulus, lowed by irritable bowel syndrome. In patients obstruction and strangulation. over the age of 50 years, the most common Post-colonoscopy appendicitis is a very rare Figure 1. Ultrasound abdomen scan reveal- indications are surveillance endoscopy for col- complication of this common procedure. ing a non-compressible, blind-ended tubu- orectal cancer and a positive fecal occult blood lar structure measuring 10 mm in diameter Vender et al.3 reported 3 cases of post- test. Colonoscopy is a relatively safe procedure. in the right iliac fossa. colonoscopy appendicitis out of approximately Post colonoscopy appendicitis is so rare that 8000 colonoscopies over two years in 2 institu- the British Society of Gastroenterology, which lists rare complications of colonoscopy, does tions. There have been approximately 14 cases not include it. The aim of reporting this case is reported in the English literature since 1988. to highlight this rare complication. Among reported cases, average age was 54.4 Conclusions Appendicitis should be included in the differen- years, the male:female ratio was 10:1 and the onset of symptoms ranges between 12 h to five tial diagnosis of right-sided lower abdominal Although post-colonoscopy appendicitis is a days.8 In our case, although the patient pre- pain following a colono scopy. Non-commercial rare entity, endoscopists should always be sented on Day 7 post procedure the onset of aware of the rare complication of this proce- symptoms was Day 4 following the dure. A high index of suspicion helps to avoid colonoscopy. Possible explanations for post- the serious consequences of a delayed diagno- Case Report colonoscopy appendicitis are: direct intubation sis of appendicitis. of appendicular lumen, local edema and A 35-year-old female patient was admitted obstruction of the appendicular lumen second- complaining of right-sided lower abdominal ary to mucosal injury around the appendiceal pain over the previous three days. She had a orifice, barotrauma, penetration of fecolith References history of nausea and vomiting for two days. inside the lumen, pumped through the colono- She underwent colonoscopy for a positive stool scope, and pre-existing sub-clinical disease of 1. Waye JD, Kahn O, Auerbach ME. occult blood test a week previously. She had no the appendix. Endoscopists should always be Complications of colonoscopy and flexible history of similar complaints and her past sur- aware of the potential complications of sigmoidoscopy. Gastrointest Endosc Clin N gical history was not significant. Colonoscopy colonoscopy and of medical imaging, and take Am 1996;6:343-77. was performed according to the standard pro- appropriate steps to investigate any post- 2. Kavic SM, Basson MD. Complications of tocol using an Olympus video colonoscope. colonoscopy abdominal pain so as to avoid a endoscopy. Am J Surg 2001;181:319-32. Colonoscopy examination was normal. delayed diagnosis of appendicitis. 3. Vender R, Larson J, Garcia J, et al. Physical examination revealed tenderness at Appendicitis as a complication of

[page 130] [Clinics and Practice 2012; 2:e55] Case Report

colonoscopy. Gastrointest Endosc Colorectal Dis 2004;6:124-5. Gastroenterol 2005;100:2815-7. 1995;41:514-16. 6. Rosen MJ, Sands BE. Acute appendicitis 8. Paula Loureiro Md, Bonin E, Leiner C, et 4. Houghton A, Aston N. Appendicitis compli- following colonoscopy. J Clin Gastroenterol al. [Case report- post-colonoscopy acute cating colonoscopy. Gastrointest Endosc 2005;39:78. appendicitis: diagnostic challenge and 1988;34:489. 7. Izzedine H, Thauvin H, Maisel A, et al. minimally invasive treatment]. Rev Col 5. Srivastava V, Pink J, Swarnkar K, et al. Post-colonoscopy appendicitis: case report Bras Cir 2011;38:365-8. [Article in Colonoscopically induced appendicitis. and review of the literature. Am J Portuguese].

only use

Non-commercial

[Clinics and Practice 2012; 2:e55] [page 131]