UCTN – Unusual cases and technical notes E175

Incidental drainage of a periappendicular abscess during colonoscopy

A 50-year-old man was referred to the of oral metronidazole and ciprofloxacin. A P. Figueiredo, V. Fernandes, J. Freitas outpatient colonoscopy clinic after a posi- computed tomography (CT) scan 1 week Department of Gastroenterology, tive fecal occult blood test during screen- after the procedure revealed no abnormal Hospital Garcia de Orta, Almada, Portugal ing for colorectal cancer. Colonoscopy, findings and the patient remained asymp- which was performed with the patient tomatic. sedated, revealed a 12-mm tumor covered Acute appendicitis is the most frequent References by normal, smooth mucosa at the site of acute abdominal emergency seen in de- 1 Oliak D, Yamini D, Udani VM et al. Can per- forated appendicitis be diagnosed preopera- the appendicular orifice. A biopsy was veloped countries. Its most common com- tively based on admission factors? J Gastro- taken, but this led to an immediate puru- plication is perforation and this may be intest Surg 2000; 4: 470–474 lent discharge occurring from the lesion followed by abscess formation [1]. Colo- 2 Ohtaka M, Asakawa A, Kashiwagi A et al. (●" Video 1). Therefore, a diagnosis of a noscopic diagnosis and treatment of a Pericecal appendiceal abscess with drainage periappendicular abscess was incidentally periappendicular abscess is rare [2]. In during colonoscopy. Gastrointest Endosc 1999; 49: 107–109 established. this case a periappendicular abscess was 3 Antevil J, Brown C. Percutaneous drainage After the patient had recovered from the incidentally discovered and drained dur- and interval appendectomy. In: Scott-Turner sedation, he was specifically questioned ing a colonoscopy. Although controversial, C, Torres J, Thepjatri N, eds. The SAGES Man- about recent abdominal symptoms and some authors suggest that abscesses such ual of Strategic Decision Making: Case Stud- recalled a transient self-limiting episode as this should be treated with broad-spec- ies in Minimal Access Surgery. New York: Springer; 2008: 329–336 of abdominal pain and mild fever 2 weeks trum intravenous antibiotics and percuta- previously. Because of the abscess drain- neous drainage. Interval appendectomy age, the patient was treated with a course should be considered in patients with a Bibliography low operative risk [3]. These options have DOI http://dx.doi.org/ 10.1055/s-0031-1291753 been declined by the patient, who re- Video 1 Endoscopy 2012; 44: E175 mains asymptomatic after 10 months of © Georg Thieme Verlag KG Biopsy of an appendicular tumor being carried follow-up. Stuttgart · New York out in a 50-year-old man with a positive result ISSN 0013-726X from fecal occult blood screening. The biopsy is Endoscopy_UCTN_Code_CCL_1AD_2AG immediately followed by the occurrence of a purulent discharge. Corresponding author Competing interests: None P. Figueiredo, MD Hospital Garcia de Orta Av. Torrado da Silva, Pragal 2801-951 Almada Portugal Fax: +351-21-2957004 [email protected]

Figueiredo P et al. Incidental colonoscopic drainage of periappendicular abscess… Endoscopy 2012; 44: E175