Prince Sean-Patrick, Huang Qitan, Dayto Denisse Camille, Sephien Andrew, Patel Varun, Chandrupatla Sreekanth
Holy Cross Health, University of Miami, Coral Gables, FL, USA.
USF Morsani College of Medicine GME Citrus Hospital Program, HCA Florida Healthcare, Pensacola, FL, USA.
Case Rep Gastroenterol. 2024 Jun 18;18(1):333-339. doi: 10.1159/000538970. eCollection 2024 Jan-Dec.
Colon cancer has seen a steady decline in incidence due to increased colonoscopy use. We can assume that this increased use, results in a higher incidence of post-colonoscopy complications such postpolypectomy syndrome, perforation and post-colonoscopy appendicitis (PCA). In this report, we present a case of PCA presenting to the emergency department within 12 h of a screening colonoscopy.
Our patient, a 77-year-old male, underwent an uncomplicated screening colonoscopy and was discharged home after briefly being monitored without any complaints. Later that day, the patient presented to the emergency department complaining of acute generalized abdominal pain. On presentation, the patient was found to be hypertensive and febrile with a distended abdomen with right lower quadrant tenderness on examination. Laboratory investigations noted an elevated white blood cell count with no evidence of acute appendicitis or focal inflammatory changes on contrast-enhanced abdominal and pelvic computer tomography. The patient was subsequently admitted and developed worsening right lower quadrant abdominal pain and distention overnight. Due to this worsening clinical condition, the decision was made to proceed with a diagnostic laparoscopy. After frank pus was found laparoscopically around the cecum and appendix, it was then converted to an exploratory laparotomy. Subsequently, a perforated gangrenous appendix was found with an erythematous and indurated cecum.
Major complications of colonoscopy can include perforation and/or post-colonoscopy bleeding which have been shown to have a respective incidence of 0.21% and 0.1%. With the anticipated rise in the number of colonoscopies, much rarer complications such as PCA with an incidence of less than 0.05% will be seen more frequently. Due to its nonspecific presentation, it is necessary for providers to consider PCA as an important differential for all patients presenting with abdominal pain after a colonoscopy.
由于结肠镜检查的使用增加，结肠癌的发病率呈稳步下降趋势。我们可以推测，这种使用的增加会导致结肠镜检查后并发症的发生率更高，如息肉切除术后综合征、穿孔和结肠镜检查后阑尾炎（PCA）。在本报告中，我们介绍了一例在筛查结肠镜检查后12小时内就诊于急诊科的PCA病例。
我们的患者是一名77岁男性，接受了一次无并发症的筛查结肠镜检查，在短暂监测后无任何不适主诉便出院回家。当天晚些时候，患者因急性全腹疼痛就诊于急诊科。就诊时，发现患者高血压且发热，腹部膨隆，检查时右下腹有压痛。实验室检查发现白细胞计数升高，腹部和盆腔增强计算机断层扫描未发现急性阑尾炎或局灶性炎症改变的证据。患者随后入院，一夜之间右下腹疼痛和腹胀加剧。由于临床情况恶化，决定进行诊断性腹腔镜检查。腹腔镜检查发现盲肠和阑尾周围有明显脓液后，改为 exploratory laparotomy（此处原文有误，推测应为“剖腹探查术”）。随后，发现一个穿孔坏疽性阑尾以及一个红斑硬结的盲肠。
结肠镜检查的主要并发症可包括穿孔和/或结肠镜检查后出血，其发生率分别为0.21%和0.1%。随着结肠镜检查数量的预期增加，像PCA这样发生率低于0.05%的罕见并发症将更频繁地出现。由于其表现不具特异性，对于所有结肠镜检查后出现腹痛的患者，医疗人员有必要将PCA视为一个重要的鉴别诊断。
