A case of cecal cancer presented with perforated appendicitis

Abstract

We report a case of cecal cancer associated with acute appendicitis. A 74-year-old man was brought into our hospital by ambulance because of lower abdominal pain. There was muscle guarding in the right lower quadrant of abdomen. Abdominal CT scan showed ascites in the right lower abdominal cavity and intraabdominal free air. Emergency laparotomy was performed under a diagnosis of panperitonitis due to gastrointestinal perforation. The remarkably swollen appendix perforated with severe inflammation, and a tumor 2 cm in diameter was found in the cecum, necessitating ileocecal resection. The histopathological diagnosis was gangrenous appendicitis with cecal cancer, type 1, 3.5×2.5 cm in size, well differentiated adenocarcinoma (pSE, ly0, v0, n1, H0, P0, stageIIIa) and the operation resulted in curability A. The patient developed peritoneal dissemination 8 months after the surgery, despite adjuvant chemotherapy. Therefore, the patient was treated by another course of chemotherapy (FOLFOX6). Acute appendicitis caused by cecal cancer is rare. To avoid overlooking cecal cancer, it is important to consider intraoperative exploration.