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appendicitis following colonoscopy

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appendicitis following colonoscopy

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    3. THE ENIGMATIC APPENDIX Variable position Variable length Arterial supply Demographics Variable pathophysiology

    4. ACUTE APPENDICITIS Catarrhal Obtructive - Mucocoele - Gangrene - perforation

    5. OBSTRUCTIVE APPENDICITIS Faecolith Pips Kinks Adhesions Worms F.B. Gallstone Hernia Endometriosis Barium Tumour

    6. FIRST APPENDECTOMY 1735 Claudius Amyand (Founder and Surgeon, St Georges Hospital, London) First to successfully remove appendix from living subject 11 yr old boy with scrotal hernia and faecal fistula

    8. PITFALLS “The novice may well smile at the long list of differential diagnoses for acute appendicitis until, as personal experience grows, the chagrin of slowly ticking off mistakes one by one from the list comes to pass” Zachary Cope (St Mary’s Hospital):The Acute Abdomen Solitary Diverticulum of caecum with diverticulitis Sigmoid colon phlegmon Tumour

    10. CASE REPORT 55 yr old Male Colonoscopy for rectal bleeding Haemorrhoids, no biopsy or polypectomy Easy day care Central/RLQ abd pain within hours Temp 38 Tender RLQ, rebound WBC 13,000 Xray: no free air or fluid levels CT

    12. Colonoscopy: A Prospective Report of Complications Jerome Waye: J. Clin. Gastroenterol 1992 2097 pt No monitoring Results: complications 39 pt (1.8%) Diagnostic Polypectomy Perforation 0 0.3% Bleeding 0 3.3% Post Polypectomy - 1.2% Synd

    13. Complications of Colonoscopy Dominitz et al Gastrointestinal Endoscopy Apr 2003 Overall rate 0.35% for diagnostic perf 0.2% bleed 0.09% Overall rate 2.3% with polypectomy perf 0.32% bleed 1.7% post polypectomy synd 1%

    14. Other Complications Bowel prep, medications Splenic injury Tearing mesenteric vessels Bacteraemia Retroperitoneal abscess Subcutaneous emphysema Snare entrapment Appendicitis

    15. APPENDICITIS FOLLOWING COLONOSCOPY Literature: First case: Houghton, Aston 1988 A few case reports This is 9th reported case

    16. Aetiology of post-colonoscopy appendicitis Coincidence? 1 in 250,000 chance >500,000 colonoscopies/yr in USA Barotrauma Faecal Impaction Polypectomy

    17. “The patient with an acute abdomen remains one of the last bastions of clinical medicine” “The appendix does not grumble – it either screams or remains silent”

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