The utility of colonoscopy after acute appendicitis in those over 40 years

Introduction
Acute appendicitis in older patients is less frequent and may be secondary to an underlying right colonic malignancy. This dictates the practice of performing colonoscopy in these patients after the resolution of appendicitis or appendi-cectomy, however, the evidence for this is limited. The objective of this study was to assess the utility of early colonoscopy (i.e.<3 months) to diagnose colonic cancer in older patients (>40 years) following acute appendicitis.

Methods
PubMed, Embase, Cochrane Library and Google Scholar were searched using the search terms 'colonoscopy' OR 'malignancy' OR 'tumour' AND 'acute appendicitis'. Data regarding the proportion of older patients (>40 years) after acute appendicitis who were detected to have a right colonic malignancy at follow-up colonoscopy within 3 months were analysed.

Results
The studies included patients from age 40-96 years (male:female=1.2:1). Colonoscopies were performed over a variable period of up to 3 years after appendicitis. None of the included studies addressed the main outcome measure sought. Instead, patients were followed up for periods ranging from 12–53 months. During this period, the incidence of colonic cancer ranged from 0.7-2.9% (mean=1.7%) which was considerably higher than that of the general population.  

Conclusions
The risk of colorectal cancer development in this population over subsequent years appears to be higher than the general population. The utility of early colonoscopy in older patients after acute appendicitis is unclear from the available data and recommendations can only be made after appropriate prospective studies are done.