Post-colonoscopy Appendicitis: A Literature Review and Guidelines for Management

Despite being rare, post-colonoscopy appendicitis is likely underdiagnosed due to nonspecific symptoms and lack of awareness. Currently, no clinical guideline exists to support early recognition. This review addresses that gap by synthesizing available evidence and proposing a structured management approach. Colonoscopy is a commonly performed procedure considered safe, although rare complications may occur. One such underrecognized complication is acute appendicitis following colonoscopy. This review synthesizes current literature on post-colonoscopy appendicitis, including incidence, pathophysiological mechanisms, clinical presentation, diagnostic considerations, and treatment strategies. We propose a structured clinical approach for early recognition to assist clinicians in distinguishing this rare condition from benign post-procedural symptoms. Increased awareness and timely imaging may reduce diagnostic delays and improve outcomes. A comprehensive literature search was conducted in PubMed, Embase, and Google Scholar. Studies published between 1980 and 2024 were screened. After reviewing abstracts from 74 articles, 21 were selected for full-text reviews, including 12 case reports and three review articles. The incidence of acute appendicitis following colonoscopy is estimated at 3.8 to 4.9 cases per 10,000 procedures. Most cases occur within 48 hours of the procedure and present with right lower quadrant pain, fever, and leukocytosis. Proposed mechanisms include increased intraluminal pressure, barotrauma, fecalith displacement, and direct appendiceal trauma. While surgical appendectomy is the primary treatment, conservative management has also been reported in selected cases. Acute appendicitis should be considered in the differential diagnosis of post-colonoscopy abdominal pain, especially when localized to the right lower quadrant. A structured approach may facilitate early recognition and prevent delayed management.