Jolly Samantha, McCullough Timothy, Gunning Thomas, Maddern Guy, Wichmann Matthias
Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, South Australia, Australia.
ANZ J Surg. 2023 Mar;93(3):602-605. doi: 10.1111/ans.18325. Epub 2023 Feb 14.
There is some evidence of the association between acute appendicitis and colorectal neoplasm in patients over the age of 40 years. Despite this, few centres routinely evaluate the colon endoscopically following an episode of appendicitis in these patients. Our aim was to investigate the incidence of colorectal neoplasm in patients aged 40 years and over who underwent screening colonoscopy following acute appendicitis.
Retrospective cohort study of patients aged 40 years and over who were diagnosed with acute appendicitis via imaging or histology between January 2015 and May 2022. Findings on subsequent screening colonoscopy were evaluated and classified according to adenomatous and non-adenomatous lesions.
A total of 176 patients met inclusion criteria, with a median age of 54 years (range 40-92) and female to male ratio of 1:1.3. One hundred patients (56%) had a colonoscopy following their admission, at a mean duration of 3.5 months post discharge. 15% of patients had an adenomatous polyp detected (10 adenomas, 4 advanced adenomas, and 1 sessile serrated adenoma), and 9% had a non-adenomatous lesion detected (8 hyperplastic polyps and 1 lipoma).
Adenoma detection rate in patients aged 40 years and over undergoing colonoscopy after acute appendicitis was 15% in our cohort. This high adenoma detection rate supports the view of appendicitis as an indication for screening faecal immunochemical testing or colonoscopy in patients above 40 years.
有证据表明40岁以上患者的急性阑尾炎与结直肠肿瘤之间存在关联。尽管如此，很少有中心会在这些患者发生阑尾炎后常规进行结肠镜检查以评估结肠情况。我们的目的是调查40岁及以上急性阑尾炎患者在接受结肠镜筛查后结直肠肿瘤的发病率。
对2015年1月至2022年5月期间通过影像学或组织学诊断为急性阑尾炎的40岁及以上患者进行回顾性队列研究。根据腺瘤性和非腺瘤性病变对随后结肠镜检查的结果进行评估和分类。
共有176例患者符合纳入标准，中位年龄为54岁（范围40 - 92岁），男女比例为1:1.3。100例患者（56%）在入院后进行了结肠镜检查，平均出院后3.5个月进行。15%的患者检测到腺瘤性息肉（10个腺瘤、4个高级别腺瘤和1个无蒂锯齿状腺瘤），9%的患者检测到非腺瘤性病变（8个增生性息肉和1个脂肪瘤）。
在我们的队列中，40岁及以上急性阑尾炎患者接受结肠镜检查后的腺瘤检出率为15%。如此高的腺瘤检出率支持将阑尾炎视为40岁以上患者进行粪便免疫化学检测或结肠镜筛查的指征这一观点。
