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Acute appendicitis following colonoscopy: causality or coincidence

Colonoscopy is a procedure performed by surgeons and gastroenterologists on a daily basis as a very useful tool for diagnosing and treating colonic disease. Medical practitioners should be aware of potential complications of procedures that they perform and know how to manage them. Major serious complications following colonoscopy include perforation and bleeding, but they are relatively rare. Acute appendicitis following colonoscopy on the other hand is a very rare condition and a differential diagnosis that rarely comes to mind when reviewing patients with abdominal pain post this procedure. There have been only 13 cases reported in English literature so far since 1988 when Houghton described the first one. To the best of my knowledge, this is the first case described in the Australian literature. I would like to present this case of acute appendicitis following colonoscopy, highlighting the importance of medical imaging and clinical judgement. A 50-year-old, previously healthy lady, without past abdominal surgery presented to the emergency department with 2-day history of pain in her right iliac fossa (RIF) and no other associated symptoms. Of note was only that she underwent surveillance colonoscopy for positive faecal occult blood test 1 week ago. The procedure itself was uneventful. On examination, she had stable vital signs and was afebrile. Physical examination revealed abdominal tenderness localized to the RIF and guarding. Blood tests did not show any abnormalities. Erect chest X-ray and abdominal X-ray were also normal. She subsequently underwent abdominal computed tomography (CT) imaging which showed a solitary finding of thickened retrocaecal appendix, with adjacent fat stranding, consistent with inflammation (Fig. 1). Based on this, the patient was taken to the operating theatre and underwent laparoscopy, which confirmed the CT scan findings, followed by laparoscopic appendicectomy. The post-operative period was uneventful and the patient was discharged home the next day. Histological examination subsequently confirmed the clinical diagnosis of appendicitis, without the presence of intraluminal faecolith. Acute appendicitis following colonoscopy is a very rare complication of this common procedure, which sometimes can cause clinical dilemma, especially in the absence of appropriate imaging to aid the diagnosis. Therefore, surgeons should always be aware Fig. 1. Axial T1-weighted magnetic resonance imaging of left thigh showing gastrointestinal stromal tumour metastasis (arrow) to adductor longus muscle.