Post-colonoscopy Right Colon Perforation Misdiagnosed as Early Appendicitis: A Case Report

Colon perforation is a rare but life-threatening emergency that may result from colonoscopy procedures, particularly in elderly patients with comorbidities. It often presents with non-specific abdominal pain that can mimic other acute abdominal conditions, including appendicitis. Early recognition and emergent repair are critical interventions needed to avoid adverse outcomes. We present an 83-year-old man with a medical history of diabetes, chronic kidney disease, hypertension, and prior colonic polyps who presented to the emergency department with severe right lower quadrant pain two days post-colonoscopy. Abdominal computed tomography demonstrated findings typical of early appendicitis, but operative exploration revealed gangrenous cecal perforation and a retroperitoneal abscess. A laparoscopic-assisted right hemicolectomy with primary anastomosis, abscess drainage, and umbilical hernia repair were performed. Postoperative recovery was complicated by clinically significant anemia and mild basilar atelectasis but resolved with supportive management. This case emphasizes the possibility of iatrogenic colon perforations to mimic more common acute conditions such as appendicitis. It is important to maintain a high index of suspicion in elderly post-colonoscopy patients to allow for timely diagnosis and intervention in order to improve health outcomes.