A Rare Cause of Painless Haematuria- Adenocarcinoma of Appendix

Abstract

Journal of Surgery IntroductionNeoplasms of the appendix are rare, accounting for less than 0.5% of all gastrointestinal malignancies and found incidentally in approximately 1% of appendectomy specimen. Carcinoids are the most common appendicular tumors, accounting for approximately 66%, with cystadenocarcinoma accounting for 20% and adenocarcinoma accounting for 10% [1]. We present a case of adenocarcinoma of appendix presenting only with a recurrent painless haematuria. Case ReportA 79 year male presented to our surgical clinic with history of recurrent attacks of painless haematuria since last 5 months. There was no history of any fever, pain abdomen or any other urinary complaints. Patient had history of similar attacks 5 months back for which he was investigated by routine haemogram and urine analysis. During that time his total leukocyte count was around 9000 cu/mm with urine analysis showed 15-20 red blood cells without any pus cells. He was taken up for cystoscopy which revealed a congested area in the bladder mucosa suggestive of cystitis. Then oral and intravenous contrast enhanced CT scan abdomen was planned which was reported to be acute appendicitis complicated by cystitis. Conservative management in the form Oshner Sherren's regiment with a plan of subsequent interval appendectomy was planned. Patient then had an uneventful recovery then with that conservative management. General physical examination at this time of presentation was unremarkable. Examination of abdomen showed mild tenderness in the suprapubic and right iliac fossa region without any palpable mass. Complete haemogram showed haemoglobin 13.23 g/dl, total leukocyte count-7000 cu/mm with differential leukocyte count showing neutrophil-72%, lymphocyte-18%, monocyte-10%. Routine urine test showed 5-7 red blood cells/high power fields. Liver function test and renal function test was within normal limits. Oral and intravenous contrast enhanced CT scan of abdomen was planned which showed a heterogeneously enhancing oblong mass lesion measuring approximately 6 × 2.5 cm replacing the appendix with the tip of the lesion having an ill-defined interface with the dome of the urinary bladder suggestive of infiltration. No evidence of intrinsic mass lesion was seen within the urinary bladder. No abdominal lymphadenopathy or free intraperitoneal free fluid was detected. Interface between the mass lesion with bowel loops, right iliac vessels and right ureter was well maintained (Figure 1). Patient was planned cystoscopy followed by exploratory laparotomy. On cystoscopy an external bulge in the anterior urinary bladder wall with an area of mucosal erosion showing mild bleeding was seen. No intrinsic mass lesion was detected in the urinary bladder (Figure 2). Exploratory laparotomy was done. Appendicular growth was seen invading the dome of the urinary bladder ( Figures 3 and 4). Right hemicolectomy with en bloc resection of invasion in urinary bladder was done. Primary Ileo transverse anastomosis with repair of the urinary bladder wall was done under...