Amini Afshin, Koury Elliot, Vaezi Zahra, Talebian Amirsina, Chahla Elie
Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri, USA.
Department of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
Case Rep Gastroenterol. 2020 Jan 20;14(1):15-26. doi: 10.1159/000505482. eCollection 2020 Jan-Apr.
The primary purpose of screening colonoscopy is the detection and subsequent removal of precancerous polyps. However, effective recognition of appendiceal lesions with a standard endoscope is often challenging and is limited to the base of the cecum and appendiceal orifice. The majority of appendiceal polyps are found incidentally following an appendectomy, though rarely they may be discovered during a colonoscopy. Despite being visualized by colonoscopy, most of these polyps are generally referred for surgical resection. The risk of developing carcinoma in patients with appendiceal polyps is likely similar to that of other colonic polyps, so it is essential for the endoscopist to examine and visualize the appendiceal orifice thoroughly. Various techniques are available to the endoscopist that can increase the accuracy of colonoscopic evaluation. These include luminal inflation and deflation, looking behind and pressing haustral folds, and repetitive passage of the scope over poorly visualized areas. To our knowledge, only 3 cases have been reported in the literature describing the discovery of obscure appendiceal polyps using colonoscopic techniques. Here we describe three cases of appendiceal orifice polyps missed on initial visualization but subsequently protruded into the cecum following prolonged examination and gentle deflation in the cecum. The endoscopist should consider the possibility of an appendiceal neoplasm, especially if other colonic polyps have been found. Endoscopists should spend adequate time examining the cecum during a screening colonoscopy to expose and thoroughly examine the appendiceal region.
筛查性结肠镜检查的主要目的是检测并随后切除癌前息肉。然而，使用标准内镜有效识别阑尾病变往往具有挑战性，且仅限于盲肠底部和阑尾开口处。大多数阑尾息肉是在阑尾切除术后偶然发现的，不过在结肠镜检查期间也可能很少被发现。尽管这些息肉可通过结肠镜检查看到，但大多数通常会被转诊进行手术切除。阑尾息肉患者发生癌变的风险可能与其他结肠息肉相似，因此内镜医师必须彻底检查并看清阑尾开口。内镜医师有多种技术可提高结肠镜评估的准确性。这些技术包括肠腔充气和放气、查看并按压结肠袋皱襞以及将内镜反复通过观察不清的区域。据我们所知，文献中仅报道了3例使用结肠镜技术发现隐匿性阑尾息肉的病例。在此，我们描述3例阑尾开口息肉，最初检查时未发现，但在长时间检查并轻柔地对盲肠进行放气后，息肉随后突入盲肠。内镜医师应考虑阑尾肿瘤的可能性，尤其是在发现其他结肠息肉的情况下。在筛查性结肠镜检查期间，内镜医师应花费足够时间检查盲肠，以暴露并彻底检查阑尾区域。
