Abstract
A 38-year-old man who visited a neighboring hospital because of a one-week history of high fever, abdominal pain and diarrhea was suspected to have acute appendicitis and was referred to the emergency clinic in our hospital. When he was first seen, the body temperature was 39.0°C, the abdomen was flat and soft, and an egg-sized tumor with tenderness was palpated in the right lower quadrant of abdomen. Blood analysis revealed increases in the white blood cell count and CRP level. An abdominal CT scan showed a retroperitoneal abscess adjacent to a swollen appendix. Perforation appendicitis was suspected and appendectomy was performed. The resected appendix showed mild degree of inflammation and thickening of the wall at the center of the appendix. The pathological diagnosis was signet ring cell carcinoma of the appendix. Postoperative colonoscopy did not reveal any tumorous lesions in the colon and rectum but multiple diverticula in the ascending colon. Edematous redness was identified in one of those diverticula, and retroperitoneal abscess due to perforation of the diverticulum was suspected. On the 19th postoperative day, the patient was admitted again to our hospital and underwent laparoscopic-assisted right hemicolectomy with D3 dissection on the 21st postoperative day. Lymph node metastasis was absent and the final histopathological diagnosis was signet ring cell carcinoma of the vermiform appendix, pSS, pN0, and fStage II. The patient has been free from recurrence as of four years after the last operation.
