S4607 Right Lower Quandary: A Rare Case of Post-Colonoscopy Appendicitis

Introduction: Post-colonoscopy appendicitis (PCA) is a rare complication of a colonoscopy, especially 1 with limited terminal ileum, cecum, and ascending colon manipulation. While bleeding and bowel perforation are the most prevalent post-colonoscopy complications, providers should recognize appendicitis in patients with acute abdominal pain following the procedure. Case Description/Methods: A 58-year-old White woman with a history of adenomatous colon polyps scheduled a routine interval screening colonoscopy. The patient’s medical history included obesity, vitamin D deficiency, B12 deficiency, and hyperlipidemia. Past surgical history noted cholecystectomy, Roux-en-Y gastric bypass, colonoscopy with polypectomy, and prior upper endoscopy. Preoperative workup and physical exam were unremarkable. The patient underwent a colonoscopy with terminal ileum intubation and uncomplicated cold biopsy polypectomies including 3 rectal polyps ranging from 4-6 mm, a descending polyp 5 mm, and a transverse colon polyp 5 mm. The pathology report confirmed all polyps were hyperplastic with no progression to malignancy. The patient tolerated the procedure well and was discharged. Within 24 hours, the patient reported subjective fever with localized lower abdominal pain and was advised by the performing gastroenterologist to present to the hospital emergency department for immediate evaluation. On arrival, Computed tomography with intravenous (IV) and oral contrast revealed peri-appendiceal inflammatory changes consistent with acute appendicitis, and the patient was admitted for surgical evaluation. Labs revealed normal complete metabolic profile, alanine transaminase, aspartate aminotransferase, lipase, C-reactive protein and a white blood cell count of 9000 cells/µl. Intravenous lactated ringer's and piperacillin/tazobactam were initiated and laparoscopic appendectomy was performed. Surgical pathology confirmed acute suppurative appendicitis. The patient was discharged the same day with an uncomplicated post-operative course. At post-op out-patient follow-up 3 weeks later, the patient reported complete resolution of symptoms. Discussion: The utility of colonoscopy has increased due to the rise of colon cancer incidence. With the expansion of screening, complication occurrence will proportionally grow. Despite limited manipulation of the cecum or ascending colon, this patient still developed PCA. While rare, post colonoscopy appendicitis should be considered in the differential diagnoses of post-procedural abdominal pain to improve outcomes with early detection and management.