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Forum Name: Gastroenterology Topics

Question: Intussuscepted Appendix Removed During Colonoscopy


 Fee73 - Fri Oct 31, 2008 5:06 pm

Hi There

I'd been suffering from changing bowel habits, right sided abdominal pain for over a year when finally I was referred for tests.

Upper GI endoscopy was completely normal. I was then sent for Colonoscopy which appear normal apart from a lump which was thought to be an enlarged ileocaceal valve. Photographs were taken and I was referred for a CT scan of the pelvis and abdomen, however the scan identified the lump as a mass/lesion of some sort and also indicated that I had appendicitis and a kidney stone. My consultant was keen to see the lump for himself so booked me in for another Colonoscopy where during examination he snared the mass (which he thought was a lipoma and was going to remove it), it burst and was full of pus. He removed the lump which was later identified by pathology as being my appendix.

Apparently my appendix had intussuscepted and I was told that this is normally due to cancer, however pathology had confirmed this wasn't the case, the appendix was normal. I've since been discharged from hopsital as having had an appendectomy during colonoscopy with no further surgery required. I'm still experiencing right sided pain deep in my side and wonder if its the kidney stone that's causing the bother? My right kidney is 6cms in size and the stone is 0.5cm in size. Could the intussuscepted appendix be due to a cancer hiding somewhere else or would the CT have picked this up? Could it be the kidney stone thats causing the probs and was the appendix only discovered by accident? I just feel I need some more information as to why this happened given that the incidence is 0.01% of having an appendiceal intussusception with a normal appendix!

I've been to hell and back as my consutant did think the mass could be cancerous and I feel I need some closure on this now so I can move on. Any help would be greately appreciated.

Fiona
 John Kenyon, CNA - Fri Dec 12, 2008 10:40 pm

User avatar Hi Fiona -

If it weren't for having been involved in two similar cases I would be scratching my head right now. There are some rare things that can happen to the appendix that no one would normally think of. Intussusception and even a tumor inside the appendix have crossed my path before, both benign. I certainly understand your concern and feel it is reasonable. However, due to the way this was discovered, pathology should have cleared up the cancer question with one caveat: this should be followed for a while, on a regular basis, probably serial colonscopies (at six months and a year probably) to be certain and to put your mind completely at ease. It may not be considered necessary, but it couldn't hurt either.

The residual pain does sound a lot like renal calculus (kidney stone). That's a rather good-sized stone you've got.

Based on my peculiar experience with suspicious (and accidental) appendix anomalies, I really don't believe there is a hidden cancer anywhere seeding tumors, at least in your case. The thing sounds perfectly legitimate, if a little bit strange.

I hope this helps answer your concerns. I would look into a follow up just to be absolutely certain, but honestly believe this probably happens more often than is realized. It all sounds solid. Please feel free to follow up with us here, especially if you have any additonal questions or anything new arises. Best of luck to you.
 Fee73 - Mon Apr 13, 2009 9:45 am

Thank you so much for your reply. I have only just found it believe it or not! I must have forgotten to tick the "notify me of replies" box!

Since I last posted I have had my right kidney removed laparoscopically due it having shrunk, become scarred and full of small stones. This was only 2 weeks ago and its hard to determine whether this is what was causing the initial pain as tje pain is still there due to surgery.

I'll certainly ask for a follow up colonoscopy just to be on the safe side. Thank you so much for your reassurance and info, its much appreciated.

Take care.

Fiona
 Fee73 - Thu Oct 01, 2009 12:56 pm

Hi There

Since my last posting the saga goes on...and on....

Since having my appendix removed during colonoscopy and having my kidney removed laparascopically, a recent CT scan has shown that part of my appendix remains and I am suffering from appendicitis. What is going on here? Any info would be much appreciated. I'm in pain just now and having two wait for another fortnight to see my surgeon for a consultation..I'm worried in case the bit of appendix ruptures and poisons me! Please help!

Fiona
 Dr.M.Aroon kamath - Sat Oct 17, 2009 10:23 pm

User avatar Hi Fee73,
I have been following your posts for some time. In your first post, posted on Fri Oct 31, 2008 5:06 pm, you had mentioned as follows... "so booked me in for another Colonoscopy where during examination he snared the mass (which he thought was a lipoma and was going to remove it), it burst and was full of pus".
This statement tends to indicate that the intussuscepted appendix was associated with an appendix mass (with an abscess).
During an 'open' or laparoscopic appedicectomy, the surgeon identifies the base of the vermiform appendix at the junction with the cecum and ligates the appendix at that spot and removes the appendix.
This may not be always feasible during colonoscopic removal of an intussuscepted appedix.(esp. ones associated with an appendix mass and abscess).
Thus, a situation known as "stump" appendicitis may result.
In your case, it is probably chronic(more correctly 'recurrent').
So, i don't think you need to be excessively worried about 'Rupture' etc. Good luck!
 Fee73 - Sun Oct 25, 2009 4:33 pm

Thank you so much for your reply, its certainly put my mind at rest. My appointment was cancelled with my consultant however I'm due to see him on October 30th when hopefully we can sort this out once and for all!

Thanks again.

Fiona : )
 Dr.M.Aroon kamath - Sun Oct 25, 2009 8:41 pm

User avatar Hi,
Thank you for the update...
 Fee73 - Mon Dec 21, 2009 12:35 pm

Hello Dr Kamath

Since I last contacted you I have undergone the laparoscopy which revealed that my appendix had not in fact been taken out afterall. During the laparoscopy it was removed along with some adhesions (I have no idea where they were because I wasn't told). I had the operation at 12pm on Friday morning and my surgeon was happy to see me go home at 6.30pm on the same night, I refused because I felt awful.

Anyway, I was discharged on Saturday morning and have been in bed since (although I am trying to get up and walk around when I can) but I am in terrible pain, worse that I was originally before surgery. My port wounds seem clean and dry and aren't inflammed but he pain under my ribs, around the navel area and up into my sternum is verging on the unbearable. I am taking Tramadol that I had at home as the hospital discharged me with no medication etc. I don't have a temperature at the moment and am urinating (although painful in the pelvic region) and my bowels have moved today (in fact that pain's gotten worse after this happened).

Any info you could give me would be so much appreciated, you've been so kind in helping me in the past.

Is it normal to have this level of pain after such a procedure? I know its only been a few days but things seem to be getting worse instead of better.

Many thanks.

Fiona
 Dr.M.Aroon kamath - Sun Jan 03, 2010 7:22 am

User avatar Hi,
The appendicectomy in your case, with all that past history, must have predictably been technically difficult. Pain following any surgery (including laparoscopic), is multifactorial. One important factor is the degree of 'manipulation' of tissues during surgery.

Manipulation is likely to be higher with technically difficult surgeries (such as in your case).

This should settle down shortly. I wish you luck!

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