Signet cell carcinoma of the appendix is the rarest and the most aggressive subtype of appendiceal malignancy, typically presenting with non-specific symptoms. We describe a case of a 62-year-old male with large bowel obstruction, with computed tomography demonstrating dilated large bowels from caecum to proximal sigmoid colon and pneumoperitoneum. Intraoperatively, closed loop obstruction caused by dense adherence of sigmoid colon to caecum was noted, which had resulted in caecal perforation. Histopathology study indicated primary appendiceal malignancy of signet cell morphology with intraperitoneal spread to sigmoid colon. Large bowel obstruction from appendiceal malignancy has rarely been reported and similar presentations have not been described in the existing literature. When left-sided large bowel obstruction is suspected to be caused by a malignant stricture, it is essential to consider transperitoneal spread of appendiceal malignancy as potential aetiology, particularly in the elderly.

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Dropped or retained appendicoliths are uncommon complication of laparoscopic appendicectomies, and rarely they have been reported to cause complications such as pelvic abscesses or enterocutaneous fistulas. We reported on a rare presentation of a pelvic abscess masquerading as urachal malignancy in a 41-year-old male, 2 years after his laparoscopic appendicectomy. As urachal malignancy could not be unequivocally excluded on imaging findings alone, en bloc resection of this mass and partial cystectomy were performed. Histopathology study revealed pelvic abscess with no evidence of malignancy and a central calcification which corresponded to a faecolith identified on pre-appendicectomy imaging. We contributed this rare presentation to the limited existing literature about complications of retained appendicoliths. As laparoscopic appendicectomies are performed commonly as the standard of care of appendicitis, care should be taken to extract appendicoliths completely to prevent complications.

Emphysematous gastritis is a rare surgical condition. Although there is a lack of a common definition, the key features of its presentation include gastric emphysema on imaging and the presence of gas-forming organisms in the gastric mucosa. In this study, we report the case of an 80-year-old Caucasian male who presented with abdominal pain; a computed tomography scan demonstrated gastric emphysema (intramural air within the stomach). After upper gastrointestinal endoscopy excluded gross perforation, ulcer, and malignancy, the patient recovered to baseline with conservative management consisting of gastric rest (nil by mouth and nasogastric tube decompression), intravenous antibiotics, and intravenous proton pump inhibitor. Given the wide pathogenic mechanisms for gastric emphysema, we recommend a conservative but cautious approach if the patient does not demonstrate clinical features of hemodynamic instability, sepsis, and peritonitis.