Emergency Right Hemicolectomy for Pericecal Masses Mimicking Acute Appendicitis: Surgeon’s Fearful Dilemma

Abstract

Objective: Unexpected conglomerated pericecal masses of uncertain etiology encountered in emergency surgery may be indistinguishable, and proper operative strategic management of these cases is a dilemma for digestive system surgeons. Starting from this point, we decided to analyze the patients in whom a right hemicolectomy was performed for the pericecal mass during an appendectomy in our regional hospital. Methods: Over 8 years between March 2011 and May 2019, 4783 patients who lived in the eastern Mediterranean area underwent emergency surgery for clinical diagnosis of acute appendicitis, and a right hemicolectomy for inflammatory pericecal mass was performed in 44 patients included in this study. Patient records were reviewed for sex, age, preoperative symptoms, preoperative imaging, operation findings, preoperative Complete Blood Count (CBC) and biochemical findings, pathology reports, length of hospital stay, mortality, and any complications encountered. Results:The histopathological examination revealed that 5 of 44 (11.4%) patients had malignancy while 27 of 44 patients (88.6%) had benign pathologies. All of the malignancies were adenocarcinoma. According to age, there was a statistically significant difference between patients with and without malignancy (P < .05). Conclusion:The pericecal mass in emergency surgery is still a diagnostic and therapeutic dilemma. Hidden appendiceal neoplasm in acute appendicitis is rare but its incidence is higher in patients presenting appendiceal inflammatory mass. On the other hand, most unexpected inflammatory pericecal masses are due to benign pathologies. The choice of the surgical procedure depends on the surgeon's and institute's experience.

Can Appendiceal Neoplasms Be Predicted in Patients with Presumed Acute Appendicitis?

“…Since appendectomy is one of the most frequently performed emergency operations both in our country and worldwide, we believe that it deserves a special approach in terms of followup and outcomes [9]. If some predictive factors for appendiceal neoplasms can be determined preoperatively, the surgical technique and follow-up strategy can be appropriately developed.…”

Appendicular Phlegmon: Current Management

“…This procedure is associated with a prolonged stay in the hospital, and it involves an ileocolic anastomosis which comes with its own set of complications like anastomotic breakdown and an intestinal fistula. This can further lead to the need of performing a stoma and the added risk of wound dehiscence [35,36]. Factors that can influence the risk of anastomotic breakdown include older patients, patients with multiple comorbidities, immunocompromised and hemodynamically unstable patients.…”