A CASE OF SIGMOID COLON CARCINOMA WITH INVASION INTO THE APPENDIX WHICH WAS DIFFICULT TO DIAGNOSE DUE TO PRECEDING SYMPTOMS OF ACUTE APPENDICITIS

Abstract

A 46-year-old woman was admitted to the hospital because of right lower abdominal pain. There were spontaneous pain and tenderness shifting from the umbilicus to the right lower quadrant of abdomen, but no rebound tenderness and muscle guarding were present. Acute appendicitis was thus suspected. Conservative therapy resulted in disappearance of inflammatory findings, but abdominal distention and constipation persisted. Abdominal CT scan suggested a possibility of tumorous lesion, and tumor markers including CEA and CA19-9 were high. Barium enema study and colonoscopy showed type 2 colonic cancer in the sigmoid colon almost encircling the lumen. When performed a sigmoidectomy with D3 dissection, we saw that the tumor had involved the appendix and right oviduct so that these organs were removed as well. Histopathologically this cancer directly invaded subserosa of the appendix. We considered that the symptoms of appendicitis appeared because the tumor involved the appendix in this case.