Case report

Adenocarcinoma of the appendix presenting as bilateral ureteric obstruction

Kamran Ahmed¹ , Robiol Hoque¹ , Sherif El-Tawil¹ , Mohammad S Khan² and Mark L George¹

¹  Department of General Surgery, St Thomas' Hospital, London, UK

²  Department of Urology, Guy's Hospital, London, UK

author email corresponding author email

World Journal of Surgical Oncology 2008, 6:23doi:10.1186/1477-7819-6-23

Published:	21 February 2008

Abstract

Background

Adenocarcinoma of the vermiform appendix is a rare neoplasm of the gastrointestinal tract. Presentation mimics acute appendicitis, but right iliac fossa mass and intestinal obstruction have also been reported. These presentations reflect various stages of a locally expanding tumour causing luminal obstruction of appendix. The investigation and subsequent management with a review of the literature is presented.

Case presentation

We report a case of appendicular adenocarcinoma found unexpectedly in a 43 year old male who presented with urinary symptoms. Cystoscopy and uretero-renoscopy showed normal bladder but external compression of the ureters and therefore bilateral stents were inserted. CT scan showed a caecal mass. After colonoscopy, that showed external compression, and diagnostic laparoscopy the patient underwent right hemicolectomy. Histopathology revealed well differentiated adenocarcinoma with signet ring morphology with multiple lymph node involvement. The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.

Conclusion

Patients with atypical manifestations related to right lower abdominal quadrant should be thoroughly investigated with an open mind. Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.