Post-colonoscopy appendicitis: Systematic review of current evidence

Area of Science:

• Gastroenterology
• Surgical Complications
• Diagnostic Imaging

Background:

• Appendicitis following colonoscopy is an exceptionally rare event.
• The precise nature of this condition, whether a true complication or coincidence, requires further investigation.
• This study systematically reviews the existing literature on appendicitis post-colonoscopy since its initial description in 1988.

Purpose of the Study:

• To systematically review and synthesize all available evidence on appendicitis occurring after colonoscopy.
• To analyze the characteristics, diagnostic methods, and management strategies for post-colonoscopy appendicitis.
• To assess the incidence and trends of this rare complication.

Main Methods:

• Comprehensive literature search of PubMed, EMBASE, and Cochrane databases up to November 2019.
• Inclusion of manually searched and cross-referenced additional references.
• Data extraction focused on patient demographics, colonoscopy indications, diagnostic timelines, imaging modalities, treatments, and outcomes.

Main Results:

• A total of 53 cases were identified, with a median patient age of 55 years.
• Diagnosis typically occurred within 24-48 hours post-colonoscopy, presenting with symptoms similar to acute appendicitis.
• Computed tomography (CT) scans are increasingly used for diagnosis; appendectomy remains the primary treatment, though antibiotics alone were successful in 33.3% of a subset of cases. A twofold increase in reported cases was observed in the last decade.

Conclusions:

• Significant variability exists in the definition of post-colonoscopy appendicitis within the literature.
• It is crucial to consider post-colonoscopy appendicitis as a differential diagnosis for patients presenting with acute abdominal pain after a colonoscopy, irrespective of its definitive classification.