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      Acute Appendicitis Caused by Colonoscopy

      case-report

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          Abstract

          A 48-year-old woman who was without any abnormal past medical history underwent colonoscopy as a screening procedure for colorectal disease. The procedure was uneventful and there was no sign of inflammation around the appendicular orifice or the luminal surface of the cecum. The patient did not complain of pain or significant discomfort throughout the procedure. She then developed pain in the right lower quadrant of the abdomen that evening and this persisted for four days. She visited the outpatient department and underwent abdominal ultrasonography, which showed a swollen appendix with a collection of pericecal fluid. Surgical exploration and appendectomy were performed; the final diagnosis was acute suppurative appendicitis. Colonoscopists should be aware of this rare complication and consider it when making the differential diagnosis of post-colonoscopy abdominal pain.

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          Most cited references12

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          Complication rates of colonoscopy in an Australian teaching hospital environment.

          Quality assurance is an important part of health-care delivery. With the high level of awareness relating to adverse events from medical care, demonstration of a high standard of practice in gastroenterology is desirable. To determine the incidence of significant complications or death within 30 days of an outpatient colonoscopy, and confirm that these are in keeping with international standards. A retrospective audit of linked endoscopy and other hospital databases and selected medical records was carried out, based on reports of 30,463 colonoscopies performed between 5 September 1989 and 31 December 1999 in the three Western Australian public teaching hospitals. A total of 23,508 colonoscopies was performed on an outpatient basis between 5 September 1989 and 31 December 1999. Post-procedural complications identified (and incidence) were: bleeding episodes 49 (0.21%), colonic perforation 23 (0.1%), abdominal pain 22 (0.09%), and others 19 (0.08%). A total of 196 patients died within 30 days of undergoing colonoscopy (0.83%), although only three deaths were attributable to the procedure itself (incidence 0.01%). Two were inpatients at the time of the procedure (outpatient mortality rate 0.004%). The combined incidence of bleeding and perforation was not significantly different between consultant endoscopists and unassisted trainees (incidence 0.21% vs 0.20%, P=0.98). The incidence of bleeding and perforation is similar to other reported series and reflects procedures performed by personnel with a wide range of endoscopic experience. The incidence of complications was not greater for trainees compared with consultant endoscopists. All bleeding episodes and the majority of perforations were associated with a therapeutic intervention. Diagnostic colonoscopy in particular is a very safe procedure.
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            Appendicitis as a complication of colonoscopy.

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              Acute appendicitis immediately after colonoscopy.

              In a 69-yr-old man we treated, acute appendicitis occurred immediately after colonoscopy was performed. There were no signs or symptoms of appendicitis before colonoscopy, including in the colonoscopic findings around the cecal end and appendicular orifice. Because appendicitis is a rare complication of colonoscopy, prompt recognition should lead to early and effective treatment.
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                Author and article information

                Journal
                Korean J Intern Med
                KJIM
                The Korean Journal of Internal Medicine
                The Korean Association of Internal Medicine
                1226-3303
                2005-6648
                December 2007
                20 December 2007
                : 22
                : 4
                : 308-311
                Affiliations
                [1 ]Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul and Uijeongbu St. Mary's Hospital, Uijeongbu, Korea.
                [2 ]Department of Surgery, The Catholic University of Korea College of Medicine, Seoul and Uijeongbu St. Mary's Hospital, Uijeongbu, Korea.
                Author notes
                Chang-Hyeok An, M.D., Department of Surgery, The Catholic University of Korea, Seoul and Uijeongbu St. Mary's Hospital, 65-1, Guemodong, Uijeongbu 480-717, Korea. Tel : 82-31-820-3998, Fax : 82-31-847-2717, achcolo@ 123456catholic.ac.kr
                Article
                10.3904/kjim.2007.22.4.308
                2687673
                18309695
                cfb10251-2c3f-4448-9843-bc6c5b7ba3d0
                Copyright © 2007 The Korean Association of Internal Medicine
                History
                : 25 August 2006
                : 21 September 2007
                Categories
                Case Report

                Internal medicine
                colonoscopy,appendicitis
                Internal medicine
                colonoscopy, appendicitis

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