Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2015; 21(27): 8462-8466
Published online Jul 21, 2015. doi: 10.3748/wjg.v21.i27.8462
Acute appendicitis following endoscopic mucosal resection of cecal adenoma
Yukako Nemoto, Junya Tokuhisa, Nagasato Shimada, Tatsuya Gomi, Iruru Maetani
Yukako Nemoto, Junya Tokuhisa, Nagasato Shimada, Iruru Maetani, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
Tatsuya Gomi, Department of Radiology, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
Author contributions: Nemoto Y did study design and manuscript preparation; Nemoto Y, Tokuhisa J and Shimada N did clinical diagnosis and management; Gomi T contributed to radiological diagnosis; and Maetani I did manuscript revision.
Institutional review board statement: The study was reviewed and approved by the Toho University Ohashi Medical Center Institutional Review Board.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors has a conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yukako Nemoto, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo 153-8515 Japan. yukako.nemoto@med.toho-u.ac.jp
Telephone: +81-3-34681251 Fax: +81-3-34681269
Received: February 9, 2015
Peer-review started: February 10, 2015
First decision: April 13, 2015
Revised: April 27, 2015
Accepted: May 21, 2015
Published online: July 21, 2015
Processing time: 163 Days and 7.1 Hours
Abstract

Endoscopic mucosal resection (EMR) allows the removal of flat or sessile lesions, laterally spreading tumors, and carcinoma of the colon or the rectum limited to the mucosa or the superficial submucosa. Acute appendicitis is the most common abdominal emergency requiring emergency surgery, and it is also a rare complication of diagnostic colonoscopy and therapeutic endoscopy, including EMR. In the case presented here, a 53-year-old female underwent colonoscopy due to a positive fecal occult blood test and was diagnosed with cecal adenoma. She was referred to our hospital and admitted for treatment. The patient had no other symptoms. EMR was performed, and 7 h after the surgery, the patient experienced right -lower abdominal pain. Laboratory tests performed the following day revealed a WBC count of 16000/mm3, a neutrophil count of 14144/mm3, and a C-reactive protein level of 2.20 mg/dL, indicating an inflammatory response. Computed tomography also revealed appendiceal wall thickening and swelling, so acute appendicitis following EMR was diagnosed. Antibiotics were initiated leading to total resolution of the symptoms, and the patient was discharged on the sixth post-operative day. Pathological analysis revealed a high-grade cecal tubular adenoma. Such acute appendicitis following EMR is extremely rare, and EMR of the cecum may be a rare cause of acute appendicitis.

Keywords: Acute appendicitis; Endoscopic mucosal resection; Cecal adenoma; Antibiotics; Computed tomography

Core tip: We report a case of a 53-year-old female who underwent colonoscopy and was diagnosed with cecal adenoma. Endoscopic mucosal resection (EMR) was performed, and she experienced right-lower abdominal pain 7 h post surgery. The following day, laboratory tests revealed a neutrophil count of 14144/mm3, and a C-reactive protein level of 2.20 mg/dL. Computed tomography also revealed appendiceal wall thickening and swelling, so acute appendicitis following EMR was diagnosed. Antibiotics were initiated leading to total symptom resolution, and the patient was discharged on the sixth post-operative day. Acute appendicitis following EMR is rare, and cecal EMR may be a rare cause of acute appendicitis.