Limits...
Perforated acute appendicitis resulting from appendiceal villous adenoma presenting with small bowel obstruction: a case report.

Chen YG, Chang HM, Chen YL, Cheng YC, Hsu CH - BMC Gastroenterol (2011)

Bottom Line: After surgical intervention, the ruptured appendix was shown to be associated with intestinal obstruction.We emphasize that in elderly patients without a surgical history, the occult cause of complete intestinal obstruction must be determined.If an appendiceal tumour is diagnosed, an intra-operative frozen section is suggested prior to selecting a suitable method of surgical intervention.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan.

ABSTRACT

Background: A villous adenoma is an extremely rare benign tumour in the appendix, in contrast to other benign appendiceal lesions. The clinical features are usually asymptomatic. Acute appendicitis is the most common complication with the lesion obstructing the orifice of the appendiceal lumen. Thus, a villous adenoma is usually found during surgical intervention for acute appendicitis. Mechanical obstruction induced by acute perforated appendicitis has been previously reported. Acute appendicitis caused by a villous adenoma presenting with acute intestinal obstruction has not been previously reported.

Case presentation: A 78-year-old woman presented to our Emergency Department with diffuse abdominal pain and tenderness. The abdominal plain film and computed tomography revealed an intestinal obstruction. After surgical intervention, the ruptured appendix was shown to be associated with intestinal obstruction. The post-operative pathologic diagnosis was an appendiceal villous adenoma.

Conclusions: This is the first report describing an appendiceal villous adenoma, which is an occasional cause of perforated acute appendicitis, presenting as a complete intestinal obstruction. We emphasize that in elderly patients without a surgical history, the occult cause of complete intestinal obstruction must be determined. If an appendiceal tumour is diagnosed, an intra-operative frozen section is suggested prior to selecting a suitable method of surgical intervention.

Show MeSH

Related in: MedlinePlus

The appendix tissue reveals villous adenoma with moderate to severe dysplasia (asterisk) located suppurative appendicitis. (Hematoxylin and eosin stain, original magnification, × 400).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3094313&req=5

Figure 3: The appendix tissue reveals villous adenoma with moderate to severe dysplasia (asterisk) located suppurative appendicitis. (Hematoxylin and eosin stain, original magnification, × 400).

Mentions: A 78-year-old woman sought evaluation in our Emergency Department with several hours history of diffuse abdominal pain and distension. On physical examination, the patient's blood pressure was 140/70 mmHg, oral temperature was 37.1°C, pulse rate was 108/min, and her respiratory rate was 22 breaths/min. The abdominal examination revealed distension with tympanic percussion and local tenderness, especially over the left lower abdominal region. No obvious muscle guarding or rebound tenderness was noted. Laboratory testing revealed a white blood cell count of 15.5 × 103/μL (95% neutrophils) and a C-reactive protein (CRP) level of 35.20 mg/dL (reference range, <0.5 mg/dL). An abdomen plain film showed dilated bowel loops in the left abdomen (Figure 1). An abdominal computed tomography (CT) scan revealed small bowel distension with an air-fluid level and a transitional region in the left lower abdomen (Figures 2). The patient was treated surgically with an exploratory laparotomy. During surgery, a ruptured inflamed appendix and an adhesion band were found. The histopathological report on the surgical specimen indicated acute suppurative appendicitis and rupture with a villous adenoma that was confined to the mucosa of the appendix and did not extend to the resection margins (Figure 3). The patient was discharged on the 10th post-operative day in a stable condition.


Perforated acute appendicitis resulting from appendiceal villous adenoma presenting with small bowel obstruction: a case report.

Chen YG, Chang HM, Chen YL, Cheng YC, Hsu CH - BMC Gastroenterol (2011)

The appendix tissue reveals villous adenoma with moderate to severe dysplasia (asterisk) located suppurative appendicitis. (Hematoxylin and eosin stain, original magnification, × 400).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3094313&req=5

Figure 3: The appendix tissue reveals villous adenoma with moderate to severe dysplasia (asterisk) located suppurative appendicitis. (Hematoxylin and eosin stain, original magnification, × 400).
Mentions: A 78-year-old woman sought evaluation in our Emergency Department with several hours history of diffuse abdominal pain and distension. On physical examination, the patient's blood pressure was 140/70 mmHg, oral temperature was 37.1°C, pulse rate was 108/min, and her respiratory rate was 22 breaths/min. The abdominal examination revealed distension with tympanic percussion and local tenderness, especially over the left lower abdominal region. No obvious muscle guarding or rebound tenderness was noted. Laboratory testing revealed a white blood cell count of 15.5 × 103/μL (95% neutrophils) and a C-reactive protein (CRP) level of 35.20 mg/dL (reference range, <0.5 mg/dL). An abdomen plain film showed dilated bowel loops in the left abdomen (Figure 1). An abdominal computed tomography (CT) scan revealed small bowel distension with an air-fluid level and a transitional region in the left lower abdomen (Figures 2). The patient was treated surgically with an exploratory laparotomy. During surgery, a ruptured inflamed appendix and an adhesion band were found. The histopathological report on the surgical specimen indicated acute suppurative appendicitis and rupture with a villous adenoma that was confined to the mucosa of the appendix and did not extend to the resection margins (Figure 3). The patient was discharged on the 10th post-operative day in a stable condition.

Bottom Line: After surgical intervention, the ruptured appendix was shown to be associated with intestinal obstruction.We emphasize that in elderly patients without a surgical history, the occult cause of complete intestinal obstruction must be determined.If an appendiceal tumour is diagnosed, an intra-operative frozen section is suggested prior to selecting a suitable method of surgical intervention.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan.

ABSTRACT

Background: A villous adenoma is an extremely rare benign tumour in the appendix, in contrast to other benign appendiceal lesions. The clinical features are usually asymptomatic. Acute appendicitis is the most common complication with the lesion obstructing the orifice of the appendiceal lumen. Thus, a villous adenoma is usually found during surgical intervention for acute appendicitis. Mechanical obstruction induced by acute perforated appendicitis has been previously reported. Acute appendicitis caused by a villous adenoma presenting with acute intestinal obstruction has not been previously reported.

Case presentation: A 78-year-old woman presented to our Emergency Department with diffuse abdominal pain and tenderness. The abdominal plain film and computed tomography revealed an intestinal obstruction. After surgical intervention, the ruptured appendix was shown to be associated with intestinal obstruction. The post-operative pathologic diagnosis was an appendiceal villous adenoma.

Conclusions: This is the first report describing an appendiceal villous adenoma, which is an occasional cause of perforated acute appendicitis, presenting as a complete intestinal obstruction. We emphasize that in elderly patients without a surgical history, the occult cause of complete intestinal obstruction must be determined. If an appendiceal tumour is diagnosed, an intra-operative frozen section is suggested prior to selecting a suitable method of surgical intervention.

Show MeSH
Related in: MedlinePlus