2019 Volume 39 Issue 5 Pages 875-879
An 82-year-old man was admitted to a clinic for right sided abdominal pain. CT examination showed an intra-abdominal abscess and he was referred to our department for treatment. He had a fever with fluid collection and hypertrophy of the appendix root, both of them seen as high contrast areas. We performed CT-guided abscess drainage, and inflammation calmed down promptly. Barium enema examination showed his ascending colon was remarkably depressed to the internal side and his appendix was not enhanced. Colonoscopy showed an appendiceal papillary tumor and ascending colonic ulcer, and results of biopsies of both revealed a suspected malignant tumor. We performed a right hemicolectomy + D3 dissection. Pathological examination diagnosed pT4b (in the ascending colon, abdominal wall), pN0, pM0, and pStageⅡc. Appendiceal carcinoma with direct invasion to ascending colon and abdominal wall and intra-abdominal abscess formation at the same time as in our case has never been reported. It is very important that when we study elderly patients with severe appendicitis, we have to suspect the existence of a malignant tumor.