Acute Appendicitis Following Colonoscopy

Background: Acute appendicitis after colonoscopy is a rare sequela and may be incidental or a true complication of colonoscopy. This review explores the cause and effect relationships between colonoscopy and the development of acute appendicitis. Methods: We conducted a systematic review of the literature to identify articles up to July 2011. The following time intervals were collated from documented cases to evaluate the natural history of postcolonoscopy appendicitis: time from colonoscopy to symptom onset, time from symptom onset to presentation (preadmission delay), and time from symptom onset to surgery. Postadmission delay was then estimated. Discussion: Paucity of published cases on postcolonoscopy appendicitis may be the result of acute appendicitis being incidental after colonoscopy or because of under-recognition of this complication. The close association between colonoscopy and the onset of symptoms of acute appendicitis suggests a relationship between the procedure and pathology. However, at present, the data available are inadequate to give firm details on the natural history of acute appendicitis after colonoscopy. Shared symptomatology and examination findings between postcolonoscopy appendicitis and common colonoscopic complications such as colonic perforation and postpolypectomy syndrome result in delayed diagnosis. Our findings suggest that delayed surgical intervention is associated with increased morbidity and mortality and is clinician dependent in a majority of cases. Conclusion: Regardless of whether postcolonoscopy appendicitis represents an incidental finding or true complication of colonoscopy, consideration of acute appendicitis as a differential diagnosis of the acute abdomen after colonoscopy is important.