Colonoscopic Diagnosis and Treatment of Periappendicular Abcsess
Background: Appendicitis is one of the most common diseases of the abdomen, and the diagnosis often can be difficult to make in atypical presentation. Colonoscopic diagnosis and treatment of asymptomatic acute appendicitis and periappendicular abscess are rare. We present an atypical case of periappendicular abscess that was drained during colonoscopy. Case report: An 80-year-old woman without obvious symptoms of appendicitis was admitted for colonoscopic polyp control. Physical examination was non-remarkable, except for slight tenderness at palpation in the lower abdomen. Laboratory tests showed a marginally high white blood cell count and a normal C-reactive protein level. Colonoscopy revealed a smooth- surfaced, ill-demarcated and sessile protrusion in the coecum. We managed to perforate the mass with the tip of a snare and a whitish fluid began to drain into the colon. The perforation was dilated and a catheter was inserted to aspire pus for bacteriological examination, which later yielded E.coli and B. fragilis. After drainage the mass obviously disappeared. Multiple biopsies were and these showed normal colonic mucosa without malignancies or inflammation. An acute abdominal ultrasound and CT scan was performed hereafter. It showed an abscess cavity, no free fluid and no visible appendix. The patient was hospitalized for 5 days for observation and discharged without symptoms and normal laboratory tests. At three-months and one-year follow up there was no sign of recurrence. Conclusion: Colonoscopic drainage, especially in combination with endosonographic examination seems to be a good option in the management of periappendicular abscess, especially in elderly patients with surgical risk.
Mette Maria Willaume Christoffersen, Orhan Bulut, and Per Jess
"Colonoscopic Diagnosis and Treatment of Periappendicular Abcsess,"
World Journal of Colorectal Surgery:
1, Article 9.
Available at: http://services.bepress.com/wjcs/vol1/iss1/art9