INTRODUCTION Malrotation of the midgut and appendiceal mucocoele are both extremely rare pathological conditions in adults. To our knowledge, there are only two reported cases in the English literature with a combination of both conditions. CASE HISTORY A 65-year-old man presented with a 10-day history of upper abdominal pain associated with abdominal bloating and weight loss. He was otherwise fit and healthy with no significant past medical history. On examination, his abdomen was soft with tenderness and palpable fullness over the left upper quadrant. The initial blood test, chest x-ray and abdominal x-ray demonstrated no significant abnormality. Computed tomography showed a 17cm x 8cm x 6cm elongated cystic mass with possible malrotation of the intestines. Histopathology showed a low grade mucinous tumour of the appendix. At 12 months following surgery, there was no evidence of recurrence or postoperative complications and the patient was discharged from the care of the colorectal team. CONCLUSIONS We report a patient with a combination of two rare conditions. This case illustrates how a combination of pathologies can present a challenge to the unwary general surgeon.
A 50-year-old woman presented with a 3-month history of alternating diarrhea and constipation, with no associated weight loss. Her only medical history was that of an emergency appendectomy 33 years ago. The patient's blood investigations and stool samples were unremarkable. Her family physician organized a virtual colonoscopy to investigate any underlying pathology. Imaging revealed a heterogeneous mass in the cecum along with several small nonpathological nodes along the draining vascular chain (Figure 1). She subsequently underwent an urgent colonoscopy which revealed a 5-cm pedunculated polyp (Paris 1p) at the cecal pole (Figure 2). Image-enhanced endoscopy revealed round pits and the absence of meshed capillary vessels (Kudo I) (Figure 3). Biopsies revealed fragments of large bowel mucosa with a diffuse increase in chronic inflammatory cells in the lamina propria and reactive lymphoid follicle. The radiological and endoscopic findings were in keeping with an inverted appendiceal remnant.
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