Metastatic Cecal Adenocarcinoma presenting as acute appendicitis

Abstract

This case report details the findings of metastatic colon cancer in an older male patient who initially presented with signs and symptoms of acute appendicitis. The patient underwent routine CT (Computed Tomography) imaging for diagnostic evaluation of appendicitis. Subsequently, the patient was found to have findings consistent with acute appendicitis secondary to obstruction from a cecal mass with evidence of hepatic and pulmonary metastases. This case report demonstrates the radiological findings of acute appendicitis secondary to metastatic colorectal disease and highlights the importance of considering underlying malignancy in cases of appendicitis occurring in older individuals.

Keywords: Appendicitis; CT; Cancer; Cecum; Colon.

Fig. 1

A panel of multiple images from patient's CT scan of the abdomen and pelvis acquired after IV contrast. The coronal reconstruction (A) shows an enlarged appendix (white arrow) measuring about 1.5 cm in thickness, with mural thickening and enhancement, and surrounding fat stranding. These findings are consistent with acute appendicitis. The sagittal image (B) shows a mass like enhancing mural nodularity in the cecum occluding the appendiceal ostium (white arrow). Images A and B also show multiple hepatic hypodensities (black asterisk) suggestive of metastatic disease. The axial image (C) shows circumferential mural thickening and enhancement of the cecum (white arrow), the site of primary adenocarcinoma. The visualized lung bases, as seen in the lung windows (D), show multiple nodules (black arrow) in the right lung base, suggestive of pulmonary metastases.