Abstract
The early detection of carcinoma of the vermiform appendix is difficult because of its rarity and few specific clinical features. In the present study, we report a case of early papillary adenocarcinoma of the vermiform appendix, detected because of the perforation of the appendiceal diverticulum. A 72-year-old woman was admitted for right lower quadrant abdominal pain. Abdominal computed tomography (CT) revealed an intraperitoneal abscess with a swollen appendix, so we performed an open laparotomy. The appendix was adhered to the retroperitoneum and formed an abscess. We performed an ileocecal resection because the thickening of the appendix was too severe to perform an appendectomy safely and we could not rule out the possibility of an appendiceal tumor. Pathological examination revealed that the papillary adenocarcinoma infiltrated the submucosal layer and a perforation of the appendiceal diverticulum. The direct invasion of the tumor to the diverticulum was not observed, we therefore concluded that the perforation of the diverticulum was caused by an elevation of the intraluminal pressure from the obstruction by the tumor. Carcinoma cells were found in another abscess of the mesappendix, so we treated it with postoperative adjuvant chemotherapy. She has remained in good health, without clinical evidence of recurrent disease for 30 months after the operation.
