Appendicitis as a manifestation of colon cancer: should we image the colon after appendicectomy in patients over the age of 40 years?

Abstract

Background: Appendicitis can be secondary to caecal pathology (polyp or cancer). Increasing age is a risk factor for malignancy coexisting with appendicitis. There is an increased coexistence of cancer post-appendicectomy in patients aged 50-54 years. This study investigates whether post-appendicectomy patients aged over 40 years should receive further colorectal imaging and follow-up.

Methods: Retrospective data were collected for 1633 patients aged 40 years and over who underwent appendicectomy in a 10-year period (1st January 2004-31st December 2014). Data were analysed for patients with histological confirmation of acute appendicitis. Incidental appendicular tumours were excluded.

Results: One thousand fifty-five (64%) patients had histological confirmation of acute appendicitis (median age 52 years; range 40-96 years). Six hundred three patients (57%) were aged 40-54 years; 452 patients (43%) were aged 55 years or over. Twenty-six (2.5%) patients were investigated post-appendicectomy. Three (11.5%) had caecal pathology: 2 adenocarcinoma, 1 benign caecal polyp. Ten (2.2%) patients aged 55 years or over had caecal pathology. Seven (1.6%) were diagnosed with caecal cancer. No patients below age 54 years were diagnosed with caecal cancer. The incidence of caecal cancer in the study population was 0.66% (40-54.9 years 0%; 55 years and over 1.6%). Patients aged 55 years or over were more likely to develop caecal pathology than patients aged 40-54 years (p = 0.006). The odds ratio of developing caecal pathology was 6.8 times greater (95% CI 1.49-31.29) in people aged 55 years and over.

Conclusions: Patients aged 55 years or over who have undergone appendicectomy should be offered colonoscopy to exclude coexistent caecal pathology.

Keywords: Appendicectomy; Appendicitis; Colon cancer.