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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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Diagnostic and Management Approach.
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Figure 5: Diagnostic and Management Approach.

Mentions: Appendicular lesions, both inflammatory and neoplastic, are notorious for atypical presentation. It is thus not surprising that the rate of this misdiagnosis is quite high particularly if solely based on clinical grounds. In conclusion, patients with atypical manifestations related to right lower abdominal quadrant should be thoroughly investigated with an open mind (Figure 5). Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.


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)

Diagnostic and Management Approach.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Diagnostic and Management Approach.
Mentions: Appendicular lesions, both inflammatory and neoplastic, are notorious for atypical presentation. It is thus not surprising that the rate of this misdiagnosis is quite high particularly if solely based on clinical grounds. In conclusion, patients with atypical manifestations related to right lower abdominal quadrant should be thoroughly investigated with an open mind (Figure 5). Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.

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