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- W3209505754 abstract "Introduction: Inverted appendices are a rare finding seen during colonoscopy. Most cases are cancerous, gynecology related, post-surgical or asymptomatic. The exact mechanism for the inversion is postulated to be due to inflammation of the appendix. Case Description/Methods: A 46 year old male, without family or personal history of gastrointestinal disorders or cancer, presented with recurrent lower right quadrant abdominal pain without relation to diet and increased bowel movements. The pain was spasmodic with improvement after defecation. He is vegetarian and denied weight loss. Physical exam and labs were normal. A prior colonoscopy had normal results approximately 10 years ago. CT scans showed incidental findings (Figures 1 and 2) without pathology. MRI did not pinpoint any lesions of the appendix or cecum. Colonoscopy showed an inverted appendix with abnormal mucosa (Figure 3). Biopsies showed colonic mucosa with a lymphoid aggregate and moderate chronic inflammation without malignancy. He also had several hyperplastic polyps in his sigmoid colon. The patient was referred to surgery for discussion regarding appendectomy and is scheduled for laparoscopic appendectomy with possible cecectomy. Discussion: In the searched databases of inverted appendices, our presentation is unique as our patient had a previous normal colonoscopy which reportedly did not show an inverted appendix. Subsequently, the patient presented with physical symptoms of appendicitis such as right lower quadrant pain and nausea but without lab findings. We postulate that the inflammation documented in biopsy may have led to the invagination of the appendix into the colon. Due to the inversion, the infected material was expelled, similar to draining an abscess which limited worsening of his clinical condition. Close observation of the CT image (Figure 4) of the inverted appendix area shows increased edema, surrounding the inverted appendix. This in turn raises some interesting questions – most times an inverted appendix is written off as asymptomatic even though histological studies may show inflammation. Given that infection may invert a post-surgical appendical stump, are we assuming presentations of an inverted appendix to be subclinical when by the nature of inversion, there is a pathological process going on? Technology is available where the expert endoscopist can remove the inverted appendix in one procedure with low risk but further investigation is required regarding whether this will be optimal for the patient.Figure 1.: Figure 1: CTAP (transverse) scan showing inverted appendix. Figure 2: CTAP (coronal) scan showing inverted appendix. Figure 3: Inverted appendix as seen during colonoscopy. Figure 4: Edematous changes surrounding inverted appendix." @default.
- W3209505754 created "2021-11-08" @default.
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- W3209505754 date "2021-10-01" @default.
- W3209505754 modified "2023-09-27" @default.
- W3209505754 title "S3512 An Infected Polyp?" @default.
- W3209505754 doi "https://doi.org/10.14309/01.ajg.0000787580.00079.d1" @default.
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