A 78 year old lady, otherwise healthy, presented to our casualty with a 2-day history of right iliac fossa pain and constipation. Examination revealed tenderness and guarding in the right iliac fossa. Rest of the abdomen was soft and bowel sounds were heard. A pre-operative diagnosis of acute appendicitis was made. Investigations showed haemoglobin of 10g%, total white blood count of 16,000 and a C-reactive protein of 80. The liver and renal function tests were normal.

An appendectomy was performed the same day and the diagnosis was confirmed to be appendicitis both intra-operatively and on histology. The post-operative period was uneventful.

She presented a month later in the emergency with intestinal obstruction. Exploratory laparotomy showed carcinoma of the caecum. A right hemicolectomy was done and histology confirmed colonic adenocarcinoma starting about 6 cm from the ileo-caecal junction. She was given adjuvant chemotherapy and was doing well about six months following the second surgery.

Learning Points

• A retrospective review of her notes showed that except for haemoglobin of 10g%, there was nothing else to suggest anything sinister during her first admission.
• Carcinoma of the Caecum and ascending colon presenting as acute appendicitis is well known.
• This occurs because of obstruction of the lumen of the appendix by the growth. Back pressure on the caecum from an obstructing ascending colonic carcinoma causing a tender caecum may also mimic appendicitis.
• Any elderly patient presenting with acute appendicitis and found to be anaemic should arouse the suspicion of a right colonic carcinoma (1).
  

From: Saba Balasubramanian and T S Chandrasekar
email: s.p.balasubramanian@sheffield.ac.uk

Reference:
1. Stuber T, Garcia A, Rosso R. Appendicitis caused by caecal carcinoma - a case report. Swiss Surg 2001;7(1):36-8.