Appendiceal Orifice Location, Inflammation, Colon polyps & Colonoscopy

Colon polyps are growths that develop on the inner lining of the colon or rectum. A polyp might be flat, slightly elevated (called sessile), on a stalk, or have a number of other morphologies (called pedunculated). There are a variety of microscopic forms of polyps (the distinction between them requires the use of a microscope), and the adenomas or sessile serrated polyps have the potential to eventually develop into cancer over the course of time. It is possible to reduce the likelihood of acquiring colorectal cancer by participating in colorectal cancer screening and having polyps removed.

Polyps near the appendiceal orifice (AO) are uncommon and can present colonoscopists with the challenge of operating in an unfamiliar endoscopic area. In addition to their potential for malignancy, appendiceal orifice polyps increase the likelihood of appendiceal blockage and subsequent appendicitis. Such polyps have historically been advised for surgical excision, which may involve appendectomy or ileocecal resection. However, this procedure is linked with greater risk as well as cost. There are currently few alternatives to surgery for removing polyps. 

Appendiceal Orifice Location

The appendiceal orifice, which is positioned at the intersection of the 3 taenia coli at the cecum pole, is described in endoscopic studies as having a "crow's foot" appearance. Additionally, it is the most accurate landmark for determining cecal intubation in conjunction with the ileocecal valve.

Appendiceal Orifice Inflammation

During a colonoscopy, the symptoms of appendiceal orifice inflammation, which include mucosal erythema, granularity, erosion/ulceration, and friability, are typically observed. These symptoms are basically identical to those that are noticed with persistent inflammation extending proximally from the rectum in ulcerative colitis. This might be brought on by an obstruction in the appendiceal orifice or an infection. Inflammation of the appendiceal orifice is characterized by lower right abdominal pain, nausea, vomiting, and fever. Untreated inflammation of the appendiceal orifice might result in a potentially fatal rupture of the appendix. Antibiotics to treat the infection and painkillers are frequently used in the treatment of inflammation of the appendiceal orifice. Surgery might be required in some circumstances to remove the appendix.

Appendiceal Orifice Polyps & Colonoscopy

The fundamental objective of colonoscopy screening is the identification and eventual excision of precancerous polyps. The appendiceal orifice and base of the cecum are the only places where appendiceal lesions can be effectively detected with a regular endoscope. About 95% of appendiceal polyps are detected by chance after an appendectomy, while they are incredibly rare to be found during a colonoscopy. 

Even though they can be seen during a colonoscopy, the majority of these polyps are often indicated for surgical resection. It is crucial for the endoscopist to carefully inspect and visualize the appendiceal orifice since patients with appendiceal polyps are at an equal risk of developing cancer as those with other colonic polyps. The endoscopist has a number of tools at their disposal to improve the accuracy of the colonoscopic examination. These involve pushing and pulling on the haustral folds, inflating and deflating the lumina, and repeatedly moving the scope over locations that are difficult to see.