The role of colonoscopy in the diagnosis of appendicitis in patients with atypical presentations.
BACKGROUND
Acute appendicitis is one of the most common causes of acute abdomen. Despite recent advances in radiologic imaging, the diagnosis of acute appendicitis may be difficult on occasion. The aims of this study were to describe the colonoscopic features of appendicitis and to determine whether colonoscopy can be used as an adjunct for the diagnosis of appendicitis in patients with atypical presentations.


METHODS
The colonoscopic findings in 21 patients (14 men, 7 women; average age 55 years) with a colonoscopic or histopathologic diagnosis of appendicitis were analyzed retrospectively. Colonoscopy was performed because diagnoses suggested by CT were other than acute appendicitis (11 patients), and/or the presenting clinical features were atypical for acute appendicitis with the duration of symptoms being 10 days or longer (17 patients).


RESULTS
The colonoscopic diagnosis was acute appendicitis for all 21 patients. Seventeen underwent appendectomy, the diagnosis being verified in all cases. Of the 4 patients whose symptoms improved without appendectomy, 3 were considered to have acute appendicitis because pus was seen to drain from the appendiceal orifice at colonoscopy. A definite diagnosis could not be made in the remaining 1 patient. Therefore, the diagnosis of appendicitis was considered confirmed in 20 of 21 patients. Colonoscopic findings in these 20 patients included hyperemia (15) and bulging (18) at the appendiceal orifice area with surrounding mucosal edema (19), and drainage of pus from the appendiceal orifice (7).


CONCLUSIONS
Colonoscopy may be useful in the diagnosis of appendicitis when the clinical presentation is atypical for appendicitis and/or imaging studies are nondiagnostic.
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Hye-Sook
HS
Chang
Suk-Kyun
SK
Yang
Seung-Jae
SJ
Myung
Hwoon-Yong
HY
Jung
Weon-Seon
WS
Hong
Jin Ho
JH
Kim
Young Il
YI
Min
Hyun Kwon
HK
Ha
Jin Cheon
JC
Kim
Chang Sik
CS
Yu
Hee Cheol
HC
Kim
Jung-Sun
JS
Kim
D000006:Abdomen, Acute / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed