Clinical Report: Acute Appendicitis Following Colonoscopy: An Uncommon Complication

Overview

A 75-year-old man developed acute appendicitis the day after screening colonoscopy with extensive lavage and cold-snare removal of two cecal adenomas. CT showed appendiceal dilation and adjacent edema without perforation, and appendectomy histopathology confirmed acute inflammation. The article describes postcolonoscopy appendicitis as rare, with approximately 70 cases reported in the literature, and reviews possible mechanisms.

Background

Colonoscopy is widely used for colorectal cancer screening and evaluation of colonic disease and is generally considered safe, although preparation, anesthesia, bleeding, perforation, and infection can be associated with complications. The article notes that more than 15 million colonoscopies are performed annually in the United States, although exact figures are unavailable. Appendicitis occurring shortly after colonoscopy was first reported in 1988, and approximately 70 cases have since been described in English-language literature. The authors distinguish cases arising within days of colonoscopy from inflammation identified during the procedure or symptoms arising weeks later, which may not be attributable to the examination.

Data Highlights

Key Findings

• The patient’s bowel preparation was poor and required prolonged, extensive lavage before visualization was adequate.

• Two sessile adenomatous cecal polyps were removed with a cold snare; neither was near the appendiceal orifice, which appeared normal during colonoscopy.

• Epigastric pain began the day after the procedure and later localized to the right lower abdomen; CT showed appendiceal dilation and adjacent edema without perforation.

• Laparoscopic appendectomy found dense adherence of the appendix to the cecum; pathology confirmed acute appendiceal inflammation without perforation, and recovery was uncomplicated.

• The article reports approximately 70 previously described cases and cites a 2024 review of 67 cases; symptoms generally began within several days of colonoscopy.

• In the literature summarized by the authors, approximately two thirds of reported cases occurred in men and the median age was in the mid-50s; the significance of the sex distribution is uncertain.

Conclusion

Acute appendicitis is an uncommon complication reported after colonoscopy, and this case occurred one day after screening with cecal polypectomy. The case and literature review describe its presentation and reported epidemiologic features without establishing a definitive mechanism.

Related Resources & Content

1. Tepelenis et al., Post-colonoscopy appendicitis: A systematic review, 2024

2. Frontiers in Surgery — Subserosal Embedding of the Appendix-Cecal Complex Resulting in Non-Visualization of the Appendix in Pediatric Laparoscopic Appendectomy: A Case Study

3. Cholangioscope-Enhanced ERAT for Diagnosing and Managing Ulcerative Colitis with Inflammation of the Appendiceal Orifice: A Case Study and Review of Existing Literature

4. Surgical Endoscopy — Comparison of Prophylactic Abdominal Drainage and Non-Drainage Following Laparoscopic Appendectomy for Perforated Acute Appendicitis: A Multicenter Propensity Score-Weighted Study

5. ASCO Publications — Risk of relapse after surgical resection of localized appendiceal adenocarcinoma.

6. Bowel Preparation in Quality Guidelines and Clinical Practice

7. Beyond the Scope: Unmasking Appendicitis Following Colonoscopy

8. Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines

9. Bowel Preparation in Quality Guidelines and Clinical Practice - PMC

10. Beyond the Scope: Unmasking Appendicitis Following Colonoscopy

11. Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines - PubMed

12. Global practices and attitudes in acute appendicitis management: the PAMAP-W international survey and Delphi consensus study on the WSES appendicitis grading system | World Journal of Emergency Surgery | Springer Nature Link

13. Post-colonoscopy appendicitis: A systematic review - ScienceDirect