A case of acute appendicitis developing after colonoscopy

A case of appendicitis complicated with colonoscopy was reported. A patient, 49-year-old male, underwent colonoscopy for the follow-up study of colonic polyp. The examination was performed without any trouble including biopsy. Four hours later, however, he began to complain of severe abdominal pain. Intestinal perforation due to mechanical damage with colonoscope was suspected and laparotomy was performed. Surgical findings showed no traumatic lesions of the colon, but a reddish, swollen and gangrenous appendix was found and removed. Post-surgical course of the patient was uneventful. There were no symptoms and signs of appendicitis before colonoscopy including colonoscopic findings around the cecal end and appendicular orifice, and the symptom began shortly after colonoscopy. These facts suggested colonoscopy causing acute appendicitis. Elevation of intraluminal pressure with infused air, pushing intestinal content into the appendix and secondary obstruction of the appendicular orifice could be the causative factors. Thus, appendicitis should be taken into consideration when acute abdomen was encountered after colonoscopy.