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Adenocarcinoma of the appendix presenting as bilateral ureteric obstruction.

Ahmed K, Hoque R, El-Tawil S, Khan MS, George ML - World J Surg Oncol (2008)

Bottom Line: CT scan showed a caecal mass.The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, St Thomas' Hospital, London, UK. kahmed198@yahoo.co.uk

ABSTRACT

Background: Adenocarcinoma of the vermiform appendix is a rare neoplasm of the gastrointestinal tract. Presentation mimics acute appendicitis, but right iliac fossa mass and intestinal obstruction have also been reported. These presentations reflect various stages of a locally expanding tumour causing luminal obstruction of appendix. The investigation and subsequent management with a review of the literature is presented.

Case presentation: We report a case of appendicular adenocarcinoma found unexpectedly in a 43 year old male who presented with urinary symptoms. Cystoscopy and uretero-renoscopy showed normal bladder but external compression of the ureters and therefore bilateral stents were inserted. CT scan showed a caecal mass. After colonoscopy, that showed external compression, and diagnostic laparoscopy the patient underwent right hemicolectomy. Histopathology revealed well differentiated adenocarcinoma with signet ring morphology with multiple lymph node involvement. The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.

Conclusion: Patients with atypical manifestations related to right lower abdominal quadrant should be thoroughly investigated with an open mind. Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.

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Related in: MedlinePlus

(a&b) – CT Scan: Bilateral hydronephrosis with associated caecal mass (arrow showing hydronephrosis).
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Figure 1: (a&b) – CT Scan: Bilateral hydronephrosis with associated caecal mass (arrow showing hydronephrosis).

Mentions: CT scan (Figure 1) showed a 5 × 4 cm caecal mass with no peritoneal or distal metastatic spread. The patient underwent colonoscopy (Figure 2) which showed extrinsic compression of the caecum, but with no intrinsic lesion.


Adenocarcinoma of the appendix presenting as bilateral ureteric obstruction.

Ahmed K, Hoque R, El-Tawil S, Khan MS, George ML - World J Surg Oncol (2008)

(a&b) – CT Scan: Bilateral hydronephrosis with associated caecal mass (arrow showing hydronephrosis).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2277416&req=5

Figure 1: (a&b) – CT Scan: Bilateral hydronephrosis with associated caecal mass (arrow showing hydronephrosis).
Mentions: CT scan (Figure 1) showed a 5 × 4 cm caecal mass with no peritoneal or distal metastatic spread. The patient underwent colonoscopy (Figure 2) which showed extrinsic compression of the caecum, but with no intrinsic lesion.

Bottom Line: CT scan showed a caecal mass.The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, St Thomas' Hospital, London, UK. kahmed198@yahoo.co.uk

ABSTRACT

Background: Adenocarcinoma of the vermiform appendix is a rare neoplasm of the gastrointestinal tract. Presentation mimics acute appendicitis, but right iliac fossa mass and intestinal obstruction have also been reported. These presentations reflect various stages of a locally expanding tumour causing luminal obstruction of appendix. The investigation and subsequent management with a review of the literature is presented.

Case presentation: We report a case of appendicular adenocarcinoma found unexpectedly in a 43 year old male who presented with urinary symptoms. Cystoscopy and uretero-renoscopy showed normal bladder but external compression of the ureters and therefore bilateral stents were inserted. CT scan showed a caecal mass. After colonoscopy, that showed external compression, and diagnostic laparoscopy the patient underwent right hemicolectomy. Histopathology revealed well differentiated adenocarcinoma with signet ring morphology with multiple lymph node involvement. The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.

Conclusion: Patients with atypical manifestations related to right lower abdominal quadrant should be thoroughly investigated with an open mind. Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.

Show MeSH
Related in: MedlinePlus