An atypical case of acute
appendicitis is reported, in which the initial presentation was not suggestive of this diagnosis. A routine work-up revealed elevated levels of inflammatory markers, an ultrasonographically normal abdomen and normal endoscopic findings in the upper gastrointestinal tract. During colonoscopy, performed 3 days after admission, the inflamed appendiceal orifice was localized and intubated using an endoscopic retrograde cholangio-pancreatography (ERCP)
catheter;
pus was aspirated. Elective
appendectomy was carried out 5 months later on the asymptomatic patient. Histological analysis revealed fibrous thickening of the appendiceal wall, correlating with an old inflammatory process, along with changes typical for acute ulcerophlegmonous
appendicitis. To the best of our knowledge, this is the first case of an endoscopically diagnosed and treated acute ulcero-phlegmonous
appendicitis. We draw the following conclusions: (1) Acute
appendicitis may present atypically, leading to an extensive clinical work-up including gastroscopy and colonoscopy. (2) This condition may be effectively treated, at least temporarily, by colonoscopic suction of appendiceal
pus, provided that clinical urgency for
laparotomy is absent. (3) Histological changes typically associated with acute ulcero-phlegmonous
appendicitis may be present in asymptomatic patients and in patients without
fever and with normal erythrocyte sedimentation rates and blood leucocyte counts. (4) Elective
appendectomy should be considered in patients with conservatively healed acute
appendicitis or periappendiceal
abscess.