Endoscopic resection of polyps located at the appendiceal orifice (AO) is challenging, and the feasibility and outcomes of endoscopic resection for cecal polyps involving AO are unconfirmed We evaluated the feasibility and outcomes of endoscopic resection for cecal polyps involving AO In this retrospective, multicenter study involving nine tertiary referral centers, we evaluated 131 patients who underwent endoscopic resection for cecal polyps involving AO The median size of polyps resected was 10 mm (range 3–60 mm) Endoscopic mucosal resection, endoscopic piecemeal mucosal resection, and endoscopic submucosal dissection were performed in 75 (573%), 31 (237%), and 5 (38%) patients, respectively The en bloc resection rate was 687% Endoscopic complete resection was achieved in 123 lesions (939%) Intraprocedural and delayed bleeding occurred in 14 (107%) and three patients (23%), respectively, and perforation occurred in two patients (15%) Seven patients (53%) underwent additional surgery because of treatment failure or recurrence Polyps of ≥20 mm in size showed significantly higher rates of perforation and additional surgery (p < 005), and a lower rate of en bloc resection (p < 0005) Patients with polyps involving ≥75% of AO circumference exhibited a significantly lower rate of en bloc resection (p < 0001), and significantly higher rates of surgery and recurrence (p < 005) Recurrence during follow-up occurred in 12 patients (156%); polyps involving ≥75% of AO circumference were an independent risk factor for recurrence Endoscopic resection of cecal polyps involving AO is safe and effective in select patients

Endoscopic Resection of Cecal Polyps Involving the Appendiceal Orifice: A KASID Multicenter Study.

Background and aim Appendicitis after colonoscopy is an exceedingly rare complication. It remains to be explored if this entity is truly a complication of colonoscopy or a coincidental occurrence of appendicitis post-colonoscopy. The aim of this study was to systematically review all the available evidence since it was first described in 1988. Methods The literature on post-colonoscopy appendicitis was searched using PubMed, EMBASE, and Cochrane databases. Additional manual search was performed and cross-checked for additional references. The search was performed up to November 2019. Data collected included demographics, reason for colonoscopy, time to diagnosis, imaging performed, management, and outcome. Results Fifty-three cases were found in the systematic review with a median age of 55 years (24-84 years). The time to diagnosis post-colonoscopy was mostly within 24-48 h. Clinical features mimicked those of common acute appendicitis. In the past decade, computed tomography scan has been the imaging choice to investigate abdominal pain after colonoscopy, mainly to rule out perforation. The mainstay of management was appendectomy (open or laparoscopy). Four of the 12 cases (33.3%) were treated successfully with antibiotics alone. There has been a twofold increase in cases reported in the past decade (2009-2019, n = 31 vs 1999-2008, n = 15). Conclusion There is a considerable variation in the definition of post-colonoscopy appendicitis in the current literature. Regardless of whether post-colonoscopy appendicitis is a true entity, it should be considered as a differential diagnosis in any patient presenting with acute abdomen following colonoscopy.

Post-colonoscopy appendicitis: Systematic review of current evidence.

Endoscopic mucosal resection (EMR) was originally described in 1973 and is currently a popular practice used in treating polyps, small adenomas, and early cancers. Although the safety of EMR has been proven in numerous studies, complications occur occasionally. We report a case in which the patient complained of severe upper abdominal pain and who was diagnosed with acute appendicitis after colorectal EMR. The patient recovered well after surgery. Cautious observation is necessary when resuming oral intake in patients who undergo colorectal EMR and who complain of postoperative abdominal pain. Observation is especially important for patients with a fecalith that may have originally existed in the appendix or in the colon near the appendix.

https://journals.sagepub.com/doi/pdf/10.1177/03000605221096273

Acute appendicitis after colorectal endoscopic mucosal resection: a case report

The purpose of this study is to review the cases of postcolonoscopy appendicitis (PCA) reported in the literature. A comprehensive search using PubMed, EMBASE, Scopus, and Google Scholar identified 57 cases. The median age at presentations of PCA was 55 years. PCAs typically occurred during the first 24 hours after colonoscopy, and the majority developed after diagnostic colonoscopy. Clinical presentations were similar to those with common acute appendicitis, though with a high perforation rate. Most patients were correctly diagnosed using ultrasound or computed tomography scan. Treatment included open appendicectomy, laparoscopic appendicectomy or cecotomy, radiologic drainage of the abscess, nonoperative treatment with antibiotics. In addition to barotrauma, fecalith impaction into the appendiceal lumen, direct trauma to the appendiceal orifice, and underlying ulcerative colitis, a pre-existing subclinical disease of the appendix seems to play an important role in the pathogenesis. For PCA, timely diagnosis and management are crucial to attain a satisfactory outcome.

Postcolonoscopy Appendicitis: A Review of 57 Cases.

Post-colonoscopy appendicitis is an infrequent complication of colonoscopy. This systematic review aimed to summarize the literature's current notions, clinical features, and management of post-colonoscopy appendicitis. PubMed and Embase were searched from inception until December 31, 2023. Two reviewers independently screened titles/abstracts and full-text papers for any study design about post-colonoscopy appendicitis and abstracted data. 56 articles with a total of 67 patients were included in the systematic review. The median age was 54.9 years (range 24-84), with more male individuals affected (64.2 %). The main indication of colonoscopy was investigation (37.3 %). Forty-three patients had colonoscopy with additional procedures (64.2 %). Most patients (79.1 %) presented with symptoms within two days after the colonoscopy. The clinical manifestation was the same as acute appendicitis. The diagnosis of post-colonoscopy appendicitis was confirmed in 70.2 % of the cases, mainly with abdominal computed tomography or, alternatively, ultrasound. Most patients were successfully treated with surgery (88.1 %), either open (56.8 %) or laparoscopic appendectomy (31.3 %). The conversion rate of laparoscopic appendectomy was 19.2 %. Non-operative management with intravenous antibiotics was attempted in 17 patients with a success rate of 41.2 %. Histopathology revealed acute appendicitis in 30 cases (44.8 %) and complicated appendicitis in 29 (49.2 %). Fecalith was found in 21 cases (31.3 %). Post-colonoscopy appendicitis is an infrequent but potential complication of colonoscopy. The onset of symptoms, especially pain, fever, nausea, and vomiting after a colonoscopy, should raise suspicion of this entity. A satisfactory outcome depends on timely diagnosis and appropriate management. 

Post-colonoscopy appendicitis: A systematic review

Endoscopic submucosal dissection (ESD) is a groundbreaking treatment for tumors adjacent to the appendiceal orifice that are difficult to remove by conventional endoscopic mucosal resection, and successful cases are increasingly reported However, little is known about the subsequent complications, especially long-term complications A female in her early 70s with a 15-mm cecal tumor adjacent to the appendiceal orifice - discovered incidentally during a screening colonoscopy - underwent hybrid ESD of the lesion We completely resected the tumor, and she was discharged 5 days later with a pathological diagnosis of high-grade tubular adenoma Ten months postoperatively, she experienced sudden-onset right lower quadrant pain and was diagnosed with acute appendicitis at another hospital Due to suspicion that her condition was the result of residual tumor, her surgeon performed an emergency laparoscopic cecectomy The pathological examination of the resected specimen showed thick scarring adjacent to the appendiceal orifice and no residual tumor The previous ESD was identified as the cause of the scar, and the scar was the only finding to account for the patient's appendicitis This case is significant because the patient required additional surgery due to a complication of ESD Further, it indicates that acute appendicitis may be a late complication of submucosal dissection near the appendiceal orifice As ESD becomes more widely used, it is likely that more cecal tumors will be treated endoscopically It is important to be aware of the late complications of ESD for these tumors

/pdf/acute-appendicitis-caused-by-previous-endoscopic-submucosal-ev0x3sn4p0.pdf

Acute Appendicitis Caused by Previous Endoscopic Submucosal Dissection for an Adenoma Adjacent to the Appendiceal Orifice.

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Acute Appendicitis Caused by Previous Endoscopic Submucosal Dissection for an Adenoma Adjacent to the Appendiceal Orifice.