Louisiana State University Health Sciences Center Lafayette, LA
Ali K. Yousuf, DO1, Phillip Henderson, DO2 1Louisiana State University Health Sciences Center, Lafayette, LA; 2University of South Alabama, Mobile, AL
Introduction: Acute appendicitis is a common medical emergency that requires immediate diagnosis and surgical intervention to prevent potential complications. Traditionally, the diagnosis of appendicitis has relied on clinical presentation and imaging studies such as computed tomography (CT) scan. However, in some cases the diagnosis may not be straightforward. Other diagnostic modalities may be required to establish definitive diagnosis. While colonoscopy is not typically used to diagnose appendicitis, it has been reported as a rare means of diagnosis. In this case report, we present a case of appendicitis diagnosed during colonoscopy. The aim of this report is to highlight the importance of considering appendicitis as a potential diagnosis and to emphasize the role of colonoscopy in the diagnostic workup.
Case Description/Methods: We present a 34 year old female with a history of cervical adenocarcinoma who presented with diarrhea, lower abdominal pain that was relieved with defecation, and bright and dark red rectal bleeding. Patient had received a CT abdomen and pelvis for ongoing monitoring that revealed inflammatory changes in the walls of the terminal ileum, cecal, descending colon. Patient underwent endoscopy for evaluation of these colonic findings, which depicted pus in the cecum. Patient was immediately transferred to ED for admission and inpatient care of acute appendicitis. Patient received re-imaging with CT abdomen and pelvis which depicted enlarged appendix with periappendiceal inflammatory changes consistent with acute appendicitis. Patient received urgent surgical intervention with laparoscopic appendectomy with resolution of her symptoms and was discharged with outpatient antibiotic regimen.
Discussion: A thorough clinical evaluation, along with a combination of imaging and other diagnostic modalities should be employed to ensure prompt and accurate diagnosis. Early recognition and treatment of appendicitis are crucial to avoid complications such as perforation, abscess formation, and sepsis, which can lead to significant morbidity and mortality. In conclusion, this case highlights the importance of considering appendicitis as a potential diagnosis in patients presenting with right lower quadrant abdominal pain, even in the absence of typical imaging findings. In this case, the diagnosis was made through colonoscopy, which is not a commonly utilized diagnostic tool for appendicitis. It is crucial to keep in mind that appendicitis can present in atypical ways.
Figure: A: CT Abdomen prior to endoscopy B: Retroflex View Cecum C: Pus Appendices Orafice D: Pus Cecum E: CT Abdomen post endoscopy F: Normal Ilium G: Normal Colon H: Myocotic Sigmoid
Disclosures:
Ali Yousuf indicated no relevant financial relationships.
Phillip Henderson indicated no relevant financial relationships.
Ali K. Yousuf, DO1, Phillip Henderson, DO2. P3412 - A Twist in the Tale: Appendicitis Detected on Colonoscopy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
