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A case of a horseshoe appendix

View Article: PubMed Central - PubMed

ABSTRACT

Anomalies of the appendix are extremely rare, and a horseshoe appendix is even rarer. A literature search has revealed only five reported cases. In this report, we present a case of a horseshoe appendix.

A 78-year-old man was referred for further examination following a positive fecal occult blood test. A mass in his ascending colon was detected on colonoscopy, while computed tomography showed that it was connected to the appendix. Tumor invasion derived from the ascending colon or appendix was suspected. We diagnosed ascending colon cancer prior to laparoscopic ileocecal resection. Macroscopic findings showed that the appendix connected to the back side of the mass, while microscopic findings showed that the mucosa and submucosa were continuous from the appendiceal orifice in the cecum to the other orifice in the ascending colon, where a type 1 tumor was observed on the orifice. We eventually diagnosed the patient with tubulovillous adenoma and a horseshoe appendix.

A horseshoe appendix communicates with the colon at both ends and is supplied by a single fan-shaped mesentery. Cases are classified by the disposal of the mesentery and the location of the orifice. Anatomical anomalies should be considered despite the rarity of horseshoe appendices.

No MeSH data available.


A 30-mm-wide mass in the ascending colon
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Fig2: A 30-mm-wide mass in the ascending colon

Mentions: A 78-year-old man was referred to us for further examination following a positive fecal occult blood test result. A mass that was possibly malignant was detected by colonoscopy in the ascending colon. There were no particular findings from physical examinations or hematological examinations, including the following tumor markers: cancer embryonic antigen and cancer antigen 19–9. Colonoscopy showed a type 1 mass in the ascending colon (Fig. 1) with submucosal invasion suspected from poor mobility. Computed tomography showed a 30-mm-wide mass in the ascending colon (Fig. 2) that was connected to the appendix. Tumor invasion derived from the ascending colon or appendix was suspected (Fig. 3). We preoperatively diagnosed ascending colon cancer, as follows: cT1, cN0, cM0, cStage1 (UICC/AJCC 7th). A standard laparoscopic ileocecal resection was then performed. Intraoperative findings showed that the appendix was connected to the ascending colon. It was suspected to be a tumor invasion and was therefore mobilized and resected carefully. Macroscopic findings showed the appendix connected to the back side of the mass, inserting along the appendiceal orifice and reaching the adenoma of the ascending colon (Figs. 4 and 5). Microscopic findings revealed that the mucosa and submucosa were continuous from the appendiceal orifice in the cecum to the other orifice in the ascending colon with a seamless muscular layer (Fig. 6). There was no evidence of inflammation or malignancy, and pathologically, the appendix was normal. There was a type 1 tumor on the orifice in the ascending colon, which was pathologically diagnosed as a tubulovillous adenoma with moderate atypia, along with an appendiceal extension. There was no evidence of lymph node metastasis. We finally diagnosed the patient with a tubulovillous adenoma and a horseshoe appendix. After undergoing the previously described surgery, the patient experienced a paralytic ileus and required fasting. He was discharged home on the 15th day after surgery.Fig. 1


A case of a horseshoe appendix
A 30-mm-wide mass in the ascending colon
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120162&req=5

Fig2: A 30-mm-wide mass in the ascending colon
Mentions: A 78-year-old man was referred to us for further examination following a positive fecal occult blood test result. A mass that was possibly malignant was detected by colonoscopy in the ascending colon. There were no particular findings from physical examinations or hematological examinations, including the following tumor markers: cancer embryonic antigen and cancer antigen 19–9. Colonoscopy showed a type 1 mass in the ascending colon (Fig. 1) with submucosal invasion suspected from poor mobility. Computed tomography showed a 30-mm-wide mass in the ascending colon (Fig. 2) that was connected to the appendix. Tumor invasion derived from the ascending colon or appendix was suspected (Fig. 3). We preoperatively diagnosed ascending colon cancer, as follows: cT1, cN0, cM0, cStage1 (UICC/AJCC 7th). A standard laparoscopic ileocecal resection was then performed. Intraoperative findings showed that the appendix was connected to the ascending colon. It was suspected to be a tumor invasion and was therefore mobilized and resected carefully. Macroscopic findings showed the appendix connected to the back side of the mass, inserting along the appendiceal orifice and reaching the adenoma of the ascending colon (Figs. 4 and 5). Microscopic findings revealed that the mucosa and submucosa were continuous from the appendiceal orifice in the cecum to the other orifice in the ascending colon with a seamless muscular layer (Fig. 6). There was no evidence of inflammation or malignancy, and pathologically, the appendix was normal. There was a type 1 tumor on the orifice in the ascending colon, which was pathologically diagnosed as a tubulovillous adenoma with moderate atypia, along with an appendiceal extension. There was no evidence of lymph node metastasis. We finally diagnosed the patient with a tubulovillous adenoma and a horseshoe appendix. After undergoing the previously described surgery, the patient experienced a paralytic ileus and required fasting. He was discharged home on the 15th day after surgery.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Anomalies of the appendix are extremely rare, and a horseshoe appendix is even rarer. A literature search has revealed only five reported cases. In this report, we present a case of a horseshoe appendix.

A 78-year-old man was referred for further examination following a positive fecal occult blood test. A mass in his ascending colon was detected on colonoscopy, while computed tomography showed that it was connected to the appendix. Tumor invasion derived from the ascending colon or appendix was suspected. We diagnosed ascending colon cancer prior to laparoscopic ileocecal resection. Macroscopic findings showed that the appendix connected to the back side of the mass, while microscopic findings showed that the mucosa and submucosa were continuous from the appendiceal orifice in the cecum to the other orifice in the ascending colon, where a type 1 tumor was observed on the orifice. We eventually diagnosed the patient with tubulovillous adenoma and a horseshoe appendix.

A horseshoe appendix communicates with the colon at both ends and is supplied by a single fan-shaped mesentery. Cases are classified by the disposal of the mesentery and the location of the orifice. Anatomical anomalies should be considered despite the rarity of horseshoe appendices.

No MeSH data available.