Cecal diverticulitis mimicking acute appendicitis

Bedel, Cihan

doi:10.18621/eurj.378652

Cited by 1 publication

(4 citation statements)

References 9 publications

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“…2,5 The rate of adenocarcinoma found concomitantly with appendicitis is only approximately 1-2%. 4,6 in the general population, but some authors have reported it as low as 0.84%. 7 However in patients over 40-years-old, this rate increases to 1.76%.…”

Section: Discussionmentioning

confidence: 96%

“…3 Perforated appendicitis with local recurrence rates as high as 28-30%, present a particular challenge, especially in the elderly. 4 When non-operative management is chosen, it is important to remember that a cecal neoplasm may hide behind confounding inflammatory changes on CT imaging.…”

Section: Discussionmentioning

confidence: 99%

“…When cecal cancer and appendicitis coexist, there are three mechanisms potentially leading to obstruction of the appendiceal lumen by the tumor: immediate proximity to the lumen, inflammatory changes from the tumor, back pressure on the cecum causing obstruction of the appendix. 4 The first case report on cecal cancer and appendicitis was published in 1906, but the association between the two has been mentioned in numerous textbooks. 2 Since appendicitis is caused by obstruction of the appendiceal lumen in over 50% of the cases, it does not come to a surprise that a malignant growth of the cecum can lead to obstruction of blood vessel and lymphatic leading to localized inflammation that leads to appendicitis.…”

Section: Discussionmentioning

confidence: 99%

“…14 Radiologic signs are appendiceal dilatation, peri-appendiceial fluid and stranding which can also be found in other conditions such as perforated non neoplastic appendicitis, mucocele of the appendix. 4 It is important to note that CT scan overdiagnosed an appendicular process as being a cecal neoplasm. Oner presented a 70-years-old male patient with right lower quadrant pain, a right lower quadrant mass described on PET/CT as a hypermetabolic mass suspected to be malignant.…”

Section: Discussionmentioning

confidence: 99%

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A wolf in sheep’s clothing: concomitant appendicitis with occult cecal adenocarcinoma

et al. 2021

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We present the case of an 89-years-old female with an atypical presentation of an obstructive acute appendicitis secondary to a cecal carcinoma. The physical exam revealed a distended abdomen with bilateral lower quadrants tenderness without rebound or rigidity. CT scan demonstrated distal small bowel obstruction and ruptured acute appendicitis. Patient was treated conservatively with nasogastric decompression, intravenous fluids, and antibiotics. She later underwent CT guided drainage of a rim-enhancing fluid collection and her symptoms eventually resolved. She returned a week later and a CT imaging showed high grade distal small bowel obstruction, and findings were a 4.5 cm diameter cecal mass. She underwent an exploratory laparotomy and modified right hemicolectomy with ileostomy for. She had an uneventful postoperative course. Pathology revealed poorly differentiated adenocarcinoma of the cecum stage III T4N1Mx. Appendectomy for appendicitis is the most commonly performed emergency operation in the world. Appendicitis are often rare in elderly, with atypical or delayed presentation and expanded differential diagnosis, making preoperative diagnosis challenging. With the increase overall risk of cancer in this age group, occult colonic carcinoma should be high in the differential diagnosis. Three mechanisms potentially leading to obstruction of the appendiceal lumen by the tumor includes: immediate proximity to the lumen, inflammatory changes from the tumor, back pressure on the cecum causing obstruction of the appendix. Despite advances in imaging, local inflammation, collections, and masses may be misleading. The diagnostic accuracy of CT scan reportedly can be as low as 54% for cecal tumors.

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