Endoscopy 2010; 42: E104
DOI: 10.1055/s-0029-1243908
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Suppurative appendicitis at colonoscopy

P.  Duarte1 , R.  Ramos1 , C.  Casteleiro Alves1
  • 1Gastroenterology Department, Centro Hospitalar Cova da Beira, E.P.E., Covilhã, Portugal
Further Information

Publication History

Publication Date:
19 March 2010 (online)

A 65-year-old man came to our emergency department with complaints of diffuse abdominal pain and a change in bowel habits for the past 4 days. He denied nausea, vomiting or fever. His medical history included diabetes mellitus, arterial hypertension, cerebral stroke, and ischemic heart disease. He had no past surgical history. On presentation, he was in good general condition and the abdomen was soft, depressive, with diffuse discomfort on palpation in the right upper quadrant, but without Blumberg sign. Laboratory tests showed leukocytosis (11|700/µL), hemoglobin at 14 g/dL, and C-reactive protein at 8.7 mg/dL (normal range < 1.0 mg/dL). Abdominal radiography and ultrasonography were normal. He was admitted with suspicion of diverticulitis.

He was still complaining of pain 5 days later, despite analgesia medication. A colonoscopy was performed, which showed a suppurative appendicitis ([Fig. 1]).

Fig. 1 Appendix bulging into cecal lumen with purulent exudation through its orifice.

After the procedure, surgical consultation was immediately requested and an abdominal computed tomography (CT) was performed. CT scan revealed an inflammatory mass with gas inside the right lower quadrant, without free peritoneal liquid. The patient underwent appendectomy and abscess drainage, and postoperative recovery was uneventful.

The diagnosis of acute appendicitis is based on clinical criteria, corroborated by laboratory data and image findings [1]. However, some situations have subtle or atypical presentations and the role of colonoscopy has been shown to be particularly useful in these situations [1] [2] [3].

Competing interests: None



P. Duarte, MD 

Gastroenterology Department
Centro Hospitalar Cova da Beira, E.P.E.

Quinta do Alvito
6200-251 Covilhã

Fax: +351-275-330001

Email: patriciaduartecovilha@iol.pt