Objective:

To describe acute appendicitis occurring after screening colonoscopy and review reported cases and proposed mechanisms.

Approach:

• Case: A 75-year-old man developed right lower abdominal pain one day after colonoscopy with extensive lavage and cold-snare removal of two cecal adenomas. CT showed appendiceal dilation and adjacent edema; laparoscopic appendectomy and histopathology confirmed acute…
• Literature review: The authors summarize prior reports of appendicitis after colonoscopy and discuss proposed mechanisms and diagnostic considerations.

Key Findings:

• Approximately 70 cases had been reported in the English-language literature; symptoms typically begin within several days of colonoscopy.
• The appendiceal orifice appeared normal during this patient's procedure, and the removed polyps were not near it.
• Proposed mechanisms include insufflation-related pressure or barotrauma and retained bowel contents entering or obstructing the appendix; these are hypotheses.

Interpretation:

The authors regard appendicitis as an uncommon colonoscopy complication, while noting that causation has been questioned. They cite evidence of increased incidence shortly after lower endoscopy and describe symptom onset within 72 hours, with no visible appendiceal-region inflammation during endoscopy, as a proposed case definition.

Limitations:

• The article notes that the true incidence is uncertain and that the frequently cited estimate of 0.0038% may be an underestimate because of limitations in data retrieval and reporting.
• The proposed mechanisms are not established as causal.

Conclusion:

Acute appendicitis should be considered in patients who develop abdominal pain after colonoscopy, particularly within the first few days. Although the temporal association does not establish causation and the incidence remains uncertain, prompt evaluation may help distinguish appendicitis from other post-procedure complications. This case documents acute, nonperforated appendicitis one day after screening colonoscopy with extensive lavage and cecal polypectomy.

Sources:

• Appendicitis After Colonoscopy: A Rare Complication