2018 Volume 43 Issue 2 Pages 196-203
A 48-year-old woman was admitted to our hospital emergency department with right lower abdominal pain and fever from the day before the visit. There were tenderness and rebound pain localized in the lower right quadrant. In the blood test, the inflammatory response increased. CT examination revealed enlarged appendix, wall thickening and abscess formation confined and lymph node enlargement along the ileocecal artery. We diagnosed abscess forming appendicitis. Since there were no symptoms of acute generalized peritonitis and the general condition was stable, we started conservative treatment. We planned to perform detailed examinations after improvement. After hospitalization, improvement of symptoms and inflammatory response was observed by antibiotic administration, so we allowed discharge from the hospital. Although abnormal findings were not observed at the later colonoscopy, CT examination revealed thickening of the appendiceal wall, liquid accumulation in the appendix, and remnant of lymph node enlargement. We suspected appendiceal tumor and performed ileocecal resection (D3 LN dissection) after adequate informed consent. Pathological findings were appendiceal mucinous carcinoma with lymph node metastasis. Abscessing appendicitis may be associated with appendiceal carcinoma. Therefore, conservative treatment should be done if possible, and examination should be performed after improvement. If there are abnormal findings, we should positively perform surgery.
