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

  • Imran MohamedEmail author
  • Sigmund Chan
  • Aneel Bhangu
  • Sharad Karandikar
Original Paper

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

Appendicitis Colon cancer Appendicectomy 

Notes

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Birmingham Heartlands HospitalBirminghamUK

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