Correspondence

An Endoscopic View of Appendicitis

N Engl J Med 1998; 339:1481November 12, 1998

Article

To the Editor:

The diagnosis of acute appendicitis is often, but not always, straightforward. Imaging studies, such as ultrasonography and computed tomography, may be helpful. When other diagnoses seem more likely, colonoscopy may be performed,1,2 although acute appendicitis may occur as a complication of colonoscopy.3,4 I describe a patient in whom appendicitis was diagnosed by colonoscopy.

A 42-year-old man was evaluated in the emergency department because of the sudden onset of poorly localized, right-sided abdominal pain with nausea and vomiting. He was afebrile, and there was no change in bowel motion. He had a history of intermittent hematochezia and had been given a diagnosis of colitis. The results of the physical examination were unremarkable. The white-cell count was 17,500 per cubic millimeter, with 83 percent granulocytes. He was thought to have colitis and underwent elective colonoscopy 10 days later.

Colonoscopy showed periappendiceal inflammation and purulent discharge from the appendiceal orifice into the cecum (Figure 1Figure 1Endoscopic View of the Cecum, Showing Periappendiceal Inflammation and Purulent Discharge from the Appendiceal Orifice (Arrow).). Emergency surgery was performed and revealed a perforated retrocecal appendix and periappendiceal abscess. Appendectomy was performed, and the abscess was drained. The patient had an uneventful recovery.

Anil Minocha, M.D.
University of Oklahoma, Oklahoma City, OK 73126

4 References

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   Said M, Ledochowski M, Dietze O, Simader H. Colonoscopic diagnosis and treatment of acute appendicitis. Eur J Gastroenterol Hepatol 1995;7:569-571
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2. 2

   Nyam DC, Davendran K, Seow-Choen F. An endoscopic diagnosis of appendicular intussusception in chronic appendicitis. Singapore Med J 1997;38:131-131
   Medline

3. 3

   Vender R, Larson J, Garcia J, Topazian M, Ephraim P. Appendicitis as a complication of colonoscopy. Gastrointest Endosc 1995;41:514-516
   CrossRef | Web of Science | Medline

4. 4

   Hirata K, Noguchi J, Yoshikawa I, et al. Acute appendicitis immediately after colonoscopy. Am J Gastroenterol 1996;91:2239-2240
   Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   ZAHIDE SIMSEK, AKIF ALTINBAS, OGUZ USKUDAR, UNSAL HAN. (2012) ROLE OF COLONOSCOPY IN THE DIAGNOSIS OF ACUTE APPENDICITIS. Digestive Endoscopy 24:1, 50-50
   CrossRef