Unveiling the Uncommon: Exploring Acute Appendicitis as a Complication of Colonoscopy and Colonoscopic EMR

Document Type

Conference Proceeding

Publication Date

10-1-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: Endoscopic mucosal resection (EMR) is a safe and effective procedure used to treat colon polyps, adenomas, and early cancers. However, complications can occur, albeit rarely. This case report describes a unique instance of acute appendicitis following colorectal EMR. Case Description/Methods: A 77-year-old man patient underwent a routine colonoscopy due to occasional constipation. During the colonoscopy, a large sessile polyp near the appendiceal orifice, positioned 2 cm opposite the ilio-cecal valve, was discovered. EMR was performed to remove the polyp, and subsequent pathology confirmed it as a tubular adenomatous serrated polyp with low-grade intraepithelial change. The patient followed a clear fluid diet on the first day post-EMR, and initially, there were no complaints. However, 24 hours after the EMR, the patient developed acute right-lower abdominal pain. Physical examination revealed tenderness in the right iliac fossa, positive rebound tenderness at McBurney's point, and a positive Murphy sign. Laboratory tests indicated an inflammatory response, with elevated white blood cell count, neutrophil count, and C-reactive protein level (Table 1). Emergency contrast-enhanced computed tomography (CT) scan showed an empty non-compressible appendix with a diameter of 8.09mm, partially thickened, and adjacent fat stranding, leading to a diagnosis of acute appendicitis following EMR (Figure 1). The patient was fasted again and received conservative therapy comprising fluids, pain medication, and antibiotic infusions. He recovered well and was discharged on the fourth day post-endoscopy. Discussion: Various factors contribute to acute appendicitis post-colonoscopy and EMR. These include increased intra-luminal pressure from over-inflation during the procedure, potential introduction of feces to the appendix during EMR, intestinal flora disturbance due to constipation history, and trauma or irritation at the resection and clipping site near the appendiceal orifice. These factors led to the development of acute appendicitis in our patient. Although resumption of oral intake is described in the literature as a potential cause, it did not play a role in our case. In conclusion, acute appendicitis should be considered as a possible cause of acute abdominal pain following colonoscopy. Colorectal EMR should be performed with greater caution, and careful observation after the operation is crucial. Prompt identification of appendicitis allows for medical therapy without the need for surgery.

Volume

118

Issue

10

First Page

S1997

Last Page

S1998

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