Korean J Med.  2015 Nov;89(5):548-552. 10.3904/kjm.2015.89.5.548.

Asymptomatic Perforated Appendicitis Presenting as a Subepithelial Sigmoid Colon Lesion at Screening Colonoscopy

Affiliations
  • 1Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea. pmcac@daum.net

Abstract

Acute appendicitis is common in all age groups. Although many patients with acuteappendicitis present with migrating abdominal pain, the initial presentation can be atypical and nonspecific. Unusual manifestations can lead to diagnostic delay, which is associated with increased morbidity and mortality. Colonoscopic findings suggestinga diagnosis of asymptomatic appendicitis include hyperemia and bulging at the appendiceal orifice area with surrounding mucosal edema, and drainage of pus from the appendiceal orifice. We report a case of asymptomatic perforated appendicitis and periappendiceal abscess that presented as a subepithelial sigmoid colon lesion at screening colonoscopy. On colonoscopy, a subepithelial lesion with pustular drainage surrounded by hyperemic mucosa was seen at the sigmoid colon. Computed tomography revealed appendicitis and a periappendiceal abscess with adjacent sigmoid colon wall thickening. The patient underwent an appendectomy, with a final diagnosis of a perforated appendicitis with a periappendiceal abscess.

Keyword

Appendicitis; Colonoscopy; Colon, Sigmoid
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