The iatrogenic caecal polyp: can it be avoided?

Abstract

A 60-year-old farmer was admitted with symptoms and signs suggestive of appendicitis. The diagnosis was confirmed at open appendicectomy where the appendix base was ligated and inverted into the caecum with a purse-string suture. Following an uneventful recovery and discharge, a barium enema identified a 2 cm filling defect in the caecal pole. A subsequent colonoscopy revealed only a tiny sessile polyp in the caecum with histology demonstrating normal colonic mucosa. This case report discusses the rare occurrence of an inverted appendix stump mimicking caecal pathology and the rationale of post-appendicectomy colonic investigation in the elderly patient.

Figure 1

Double contrast barium enema films demonstrating a smooth filling defect in the caecal pole.

Figure 2

Double contrast barium enema films demonstrating a smooth filling defect in the caecal pole.

Figure 3

Endoscopic photograph depicting an inverted appendix stump. Reprinted with permission of the Society of Laparoendoscopic Surgeons.