A Case to Remember

74 CASE REPORT 1 T his 63 year old Caucasian man with past medical history significant for hypertension, arthritis, prostate cancer status post radiation therapy, and a family history of colon and pancreatic cancer presented to the emergency department with right lower quadrant pain. The WBC count was 10.1, Hct 41, Plt 213, Amylase 34 and Lipase 83. CT scan of the abdomen revealed a dilated appendix with thickened wall and severe stranding changes consistent with appendicitis. The appendix was grossly inflamed on open appendectomy without evidence of perforation. Histopathology revealed fibrous obliteration of the lumen of the appendix consistent with appendicitis and periappendicitis. His postoperative course was uneventful, and he was d i s c h a rged 48 hours after surg e r y. Three months later, on routine screening colonoscopy he was noted to have a 1.5-cm soft mass arising from and within the appendiceal orifice. The remainder of the colon was only notable for left-sided diverticulosis. The full extent of the mass could not be exposed from the residual lumen of the appendicular stump, and it was judged that a complete and safe endoscopic resection was not feasible. Biopsy of the cecal mass revealed tubular villous adenoma with marked focal dysplasia. (Figure 1A). The preoperative Adult Onset Appendicitis: Colonscopy Should be Part of the Routine Evaluation in the Early Postoperative Period A CASE TO REMEMBER