Benign appendiceal intussusception masquerading as caecal carcinoma intraoperatively in an adolescent male: a case report
Muhammad Wajid Siddique, Muhammad Zeshan, Ali Husnain, Muhammad Hanzla Shahzad, Muhammad Hassaan Javaid, Raghabendra Kumar MahatoIntroduction:
Appendiceal intussusception is a rare phenomenon that can mimic acute appendicitis, ileocecal intussusception, and even cecal malignancy, both clinically and intraoperatively. It becomes more difficult to recognize when the appendix is not seen on exploration.
Case presentation:
A 17-year-old man presented with 4 days of right iliac fossa pain, nausea and vomiting, anorexia, and 3 weeks of episodic right-sided abdominal pain. The patient had local peritonism, an Alvarado score of 8/10, leukocytosis, and nondiagnostic ultrasonography. We did not perform a contrast-enhanced computed tomography (CT) scan, in accordance with our institution’s practice. During laparotomy, the appendix was not found, even after cecal mobilization and a systematic search along the taeniae coli. A dimple on a thickened, edematous, and ischemic cecum raised suspicion of ileocecal intussusception or a cecal tumor. Limited ileocecal resection with primary ileocolic anastomosis was performed with informed consent from the family. Pathology showed complete appendiceal intussusception with transmural ischemic necrosis and acute inflammation without any evidence of malignancy, polyp, mucocele, or endometriosis. There was no evidence of malignancy in four regional lymph nodes.
Discussion:
A cecal dimple in the setting of an otherwise absent appendix should alert us to the diagnosis of appendiceal intussusception. A CT scan would be helpful for identifying the problem preoperatively if ultrasonography is inconclusive.
Conclusion:
Complete appendiceal intussusception can masquerade as cecal malignancy. Awareness of this rare entity may prevent unnecessarily extensive resection while ensuring appropriate treatment of ischemic bowel.