Complete Invagination of Vermiform Appendix with Adenocarcinoma

Abstract

Primary adenocarcinoma of the appendix is a rare neoplasm (1 8) and intussusception of the appendix is also rare (1). The most common presentation of appendiceal adenocarcinoma is that of acute appendicitis (2). It has seldom been diagnosed preoperatively, however, and is frequently an incidental finding at the time of surgery for unrelated conditions (3). We report a case of adenocarcinoma in a 39-year-old man whose initial complaint was right lower abdominal pain, and which involved intussusception of the appendix with the leading point. Case ReportA 39-year-old man was admitted to our hospital complaining of right lower abdominal pain, first noted one month earlier. He had a five-month history of epigastric pain and during that time his body weight had decreased by 8 kg. Physical examination revealed equivocal tenderness in the right lower quadrant without palpable mass. The white blood cell count was within normal range and the hemoglobin level was 9.5g/dl, and other laboratory findings were non-specific. Initial differential diagnoses were appendicitis, diverticulitis, or malignancy originating in the bowel.Barium enema showed a fungating filling defect in the medial wall of the cecum and this was thought to be the result of extrinsic compression by a periappendiceal abscess or a submucosal mass such as lymphoma (Fig.1A).Retrospective review of the findings of barium enema revealed a movable finger-like filling defect at the top of the cecal mass (Figs. 1A, B). Abdominal CT demonstrat-Appendiceal intussusception is a very rare pathological condition, an incidence, as revealed by appendectomy specimens, of only 0.01 percent. There are various types among which complete invagination of the appendix is very rare. We encountered a case of intussusception of the appendix with complete invagination induced by appendiceal adenocarcinoma. A preoperative diagnosis of appendiceal adenocarcinoma and intussusception was not possible, but a final pathological report confirmed these conditions and retrospective analysis of a barium enema showed a finger-like filling defect of the cecum, a relatively specific finding in such cases. We describe a case involving a 39-year old man who one month earlier had noted the onset of pain in the right lower abdomen.