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Ting-Ying Lee, Chia-Wen Wang, De-Chuan Chan, Guo-Shiou Liao, Hsiu-Lung Fan, Teng-Wei Chen
(Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan)
Med Sci Case Rep 2018; 5:10-13
Colon carcinoma arises from the mucosa and can invade adjacent tissues, resulting in fistula. Generally, colonic fistula can be identified based on imaging studies, including abdominopelvic computed tomography (CT) and colonoscopy. In specific situations, complications, including cecal inflammation or acute appendicitis may result in peri-colonic fatty stranding, and a colonoscopy exam may be contraindicated. Colon cancer can be difficult to detect and treat appropriately in these cases.
CASE REPORT: A 74-year-old man presented with fever and right iliac pain for several days. He was initially diagnosed with acute appendicitis and treated with laparoscopic appendectomy. Refractory peritoneal abscess complicated by cecal fistula then presented after surgical evaluation. He then underwent exploratory laparotomy with right hemicolectomy, and an impacted cecum tumor was found. The pathological report confirmed adenocarcinoma.
CONCLUSIONS: An inflammatory cecum tumor complicated by acute destructive appendicitis makes diagnosing this malignant neoplasm challenging. Abdominopelvic CT may be a helpful tool to detect the difficult disease.