title: Perforated appendicitis after colonoscopy.
abstract: BACKGROUND
  Acute appendicitis is a rare complication of colonoscopy that has been reported only 12 times in the English-language literature and is usually associated with obstruction of the appendiceal lumen with fecal matter during colonoscopy. None of the previous reports have described findings of perforation of the appendix within 24 hours of colonoscopy.
  
  
  METHODS
  We present the case report of a patient who underwent urgent laparotomy within 16 hours of colonoscopy for findings of free intraabdominal air and peritonitis from acute perforated appendicitis.
  
  
  RESULTS
  Laparoscopy confirmed 2 perforations of the appendix and diffuse peritonitis. Laparotomy was necessary to perform appendectomy, exclude a right colonic injury, and control intraabdominal sepsis.
  
  
  CONCLUSIONS
  In patients with abdominal pain who have had a recent colonoscopy, a high index of suspicion is necessary for accurate diagnosis of perforated appendicitis. Perforation can occur hours after colonoscopy even when a biopsy is not performed.
authors.affiliation: Department of Surgery, University of California at San Francisco, San Francisco, California 94103-0790, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Johnston
authors.forename: John
authors.initials: J
authors.lastname: Maa