Intussusception of the Appendix Resected at Colonoscopy

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Intussusception of the appendix is an uncommon condition, and the diagnosis is rarely made preoperatively, although the condition may be suspected on the basis of radiological studies and colonoscopy [1]. Colonoscopy may in fact be the procedure of choice for both diagnosis and for selecting the appropiate course of management [2]. We report a case in which an intussusception of the appendix was resected colonoscopically.

A 41-year-old woman presented with a 4-day history of rectal tenesmus, diarrhea, and recurrent severe paroxysmal abdominal pain. Colonoscopy examination revealed an intussusception of the appendix (Figure [1]). In this case a colonoscopic appendectomy was performed succesfully with the use of an endoloop ligating system (MAJ-254, HX-20L/Q/U-1; Olympus, Hamburg, Germany). The endoloop was attached over the appendix and then an appendectomy was succesfully performed with a polypectomy snare wire (Figure [2]). The pathology report confirmed the diagnosis of intussusception of the appendix and the patient made a satisfactory recovery without complications. Colonoscopy should therefore be considered as an excellent choice of treatment in such cases and should be remembered as a second option in patients in whom laparoscopic treatment fails to lead to resolution of the condition.

Figure 1 Colonoscopic view showing an intussusception of the appendix.

Figure 2 The intussusception was resected endoscopically using an endoloop, seen here over the cecum after the appendectomy.

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References

• 1 Casteels M, Eggermont E, Kerremans R. et al . Intussusception of the vermiform appendix: a preoperative diagnosis in an adolescent girl.  J Pediatr Gastroenterol Nutr. 1986;  5 159-162
• 2 Ozuner G, Davidson P, Church J. Intussusception of the vermiform appendix; preoperative colonoscopic diagnosis of two cases and review of the literature.  Int J Colorectal Dis. 2000;  15 185-187