Villous adenoma causing acute appendicitis

Abstract

Acute appendicitis is the most common of surgical emergencies. However, it is very unusual to find a benign neoplastic lesion causing appendicitis. Adenomas of the caecum or the appendix are rare and very few cases of these associated with appendicular inflammation have been described. This report presents a case of acute appendicitis with perforation resulting from obstruction by an adenoma. The management of the condition is discussed.

Invasive Carcinoma Arising in Villous Adenomata of the Appendix

“…ADENOCARCINOMA of the appendix IS rare, with about 200 cases on record Villous adenoma of the appendix IS an even rarer lesion, with 43 cases reported (Munk, 1977) Since in one large series (Grinnel and Lane, 1958) 31 % of villous adenomas of the colon and rectum had undergone malignant change at the time of excision, it has been assumed that v~llous adenoma of the appendix has a similar potential, although this has not been well documented This paper reports two patients presenting with acute appendicitis who had a villous adenoma with malignant change in the appendix CLINICAL RECORDS PATIENT 1 -An 85 year old woman presented with a six-week history of intermittent central colicky abdominal pain which over the 24 hours prior to her admission to hospital had become localized to the right iliac fossa It was associated with malaise nausea and vomiting There was no change in bowel habit nor any other symptom of note The relevant clinical findings were abdominal tenderness with guarding and rebound tenderness in the right iliac fossa Her white cell count was elevated at 19 4 x 10 bll, with 94% neutrophils The haemoglobin level was 10 9 g/dl with hypochromia and microcystosis There were no other biochemical abnormalities A clinical diagnosis of acute appendicitis was made Laparotomy through a right paramedian incision revealed a grossly dilated appendix with acute inflamrratory changes The proximal portion was indurated and a polypoid mass could be felt extending into the caecum There was no evidence of serosal or nodal involvement and no liver metastases were palpable Examination of the rest of the large bowel showed no abnormality A right hemicolectomy was done the patient making an uneventful recovery…”

“…Occasionally a mass is felt in the base of the appendix, and the question of tumour arises. If the diagnosis is uncertain, then caecotomy has been advised to determine the nature of the lesion, as tumours may be confused with faeces or inflammation (Munk, 1977). If it is neoplastic, right hemicolectomy is the procedure of choice.…”