eP526 - Unraveling the Enigma: Acute Appendicitis Following Routine Colonoscopy - A Rare Complication and Differential Diagnostic Challenge

Purpose/Background: Colonoscopy, a routine medical procedure, has emerged as a cornerstone for both screening and therapeutic purposes. Acute appendicitis after colonoscopy is a rare complication with an incidence of 0.03%. The first such case was reported in 1988 by Houghton and Aston. Colonoscopy's associated complications span the spectrum from benign, such as abdominal pain (0.09%), often attributed to retained carbon dioxide or colonic spasms, to life-threatening scenarios like intestinal perforation (0.1%), severe bleeding (0.21%), and the intriguing post-polypectomy syndrome. We present a case of abdominal pain diagnosed with acute appendicitis following a routine colonoscopy.Methods/Interventions: A 51-year-old female with a past medical history of colon polyps presented to the ER with right-sided abdominal pain, emesis, and fever. She underwent a colonoscopy a day earlier and had a polypectomy of a rectosigmoid polyp with cold biopsy forceps. Her symptoms started within 6-8 hours after her colonoscopy. She was febrile to 102.5°F and tachycardic with a heart rate of 126 bpm on presentation. She was tender in the right lower quadrant with focal guarding. Labs are significant for white blood count (WBC) of 14.7 B/L, and hemoglobin of 13.8 g/dl. Computed tomography of the abdomen and pelvis showed a dilated, fluid-filled appendix with fat standing and peri-appendiceal fluid consistent with acute appendicitis without perforation.Results/Outcomes: She received intravenous antibiotics and underwent laparoscopic appendectomy in a standard fashion. Intra-operative findings were significant for hyperemic, dilated appendix with perforation of the mid portion of the appendix and purulent peritonitis. She tolerated her diet post-operatively and was discharged home on post-operative day one on oral antibiotics for four days.Conclusion/

Discussion: In the world of colonoscopy, abdominal pain stands as the most frequent complaint to patients. This case underscores the need for a broad differential diagnosis and a meticulous evaluation of patients with abdominal pain after colonoscopy. To improve patient outcomes, it is crucial to tell apart appendicitis from potentially severe post-polypectomy syndrome, both of which have a similar constellation of symptoms, including abdominal pain, peritoneal irritation, leukocytosis, and fever after colonoscopy."CT findings with acutely inflamed and dilated appendix consistent with acute appendicitis.

Coronal view
CT findings with acutely inflamed and dilated appendix consistent with acute appendicitis.

Axial View"