Interactive Transcript
0:01
So, another patient presenting with right
0:02
lower quadrant pain that's not necessarily
0:04
an appendicitis in this particular case.
0:07
Again, following that colon
0:08
down till we reach the cecum.
0:10
You can already spot it over here that
0:12
there's an inflamed, thickened, fluid-
0:14
filled tubular structure with lots of
0:16
inflammation and lymph nodes around it.
0:19
But always keep things in order if you can.
0:21
And so I continue to follow that cecum down
0:26
and now we see where the
0:26
structure is arising from.
0:28
This is the appendix.
0:30
But it does look a little bit different
0:31
than all the other cases that I showed you.
0:33
If you put a measurement on it, this is easily
0:35
going to be, you know, 16 to 20 millimeters.
0:38
This is way larger than that 6-
0:40
millimeter cutoff that we usually use.
0:42
There's a lot of inflammation and there's a
0:43
whole lot of lymph nodes, which we generally
0:45
don't see with an acute appendicitis
0:47
because it's happening so quickly.
0:49
So in a case like this, when it's this dilated
0:52
and this fluid-filled, you want to stop and
0:54
take a second to think, could this be something
0:56
else that's causing an acute appendicitis?
0:59
So I would agree, we do have an
1:00
acute appendicitis here, that-
1:02
appendix is absolutely wildly abnormal.
1:04
It is inflamed, it's thickened, it's enhancing.
1:07
But we're looking for an obstructed
1:09
region right here, reason right here.
1:12
And you can see here in the cecum, the
1:13
cecum itself is thick-walled and enhancing.
1:16
And this to me is more than
1:17
just reactive cecal thickening.
1:20
Reacting to that acute appendicitis.
1:21
This itself is the abnormality.
1:24
And that would also explain
1:25
why we have lymph nodes here.
1:26
So you could say, is this an
1:28
inflammatory process of the cecum?
1:30
And I would argue that it's not because the
1:31
inflammation is centered around the appendix.
1:34
It is not centered around the cecum.
1:35
So we do not have, you know, focal colitis
1:37
that's also causing an acute appendicitis,
1:40
but we do have lymph nodes and lymph nodes
1:42
imply something more chronic is going on here.
1:45
So in a case like this, I would be most
1:47
concerned for a cecal cancer that's
1:50
obstructing and causing acute appendicitis.
1:53
And in particular, in my experience
1:54
with cases like these, the cecal cancer
1:56
is not an acute obstructive process.
1:58
It's more of a chronic, ongoing thing.
2:00
So it obstructs it very slowly,
2:02
which allows that cecum to dilate.
2:04
much more than you would see in a
2:06
normal acute appendicitis, which
2:08
is a relatively acute obstruction.
2:10
And so in these cases, that appendix
2:12
will be allowed to get way, way, way
2:14
bigger until it finally becomes an
2:15
inflamed, um, potentially perforates.
2:18
So in this case, the operation is the same.
2:20
They need an operation immediately.
2:22
But it's really good for the surgeon to
2:24
have an idea ahead of time that they may
2:26
be doing a partial colectomy in this case,
2:28
maybe they would get a different surgeon,
2:30
you know, colorectal surgeon to come in,
2:32
but it's good to know that ahead of time.
2:34
So potentially have the patient have
2:35
one operation instead of one for the
2:37
acute appendicitis and a second to
2:39
come back and do a hemicolectomy.
2:41
So it is really useful to the surgeon
2:42
to know that you might suspect that
2:44
there's an underlying cecal mass
2:46
causing this acute appendicitis.
2:48
So again, just to recap.
2:50
The, the salient findings in a
2:52
case like this, you'll see abnormal
2:53
cecal thickening enhancement.
2:55
You may see lymph nodes that may be
2:57
from the cancer itself because this
2:58
is a more chronic process that's
3:00
resulting in this acute appendicitis.
3:03
And then finally, the appendix
3:04
itself will be more dilated than it
3:06
normally is in acute appendicitis.
3:08
Those, again, will be greater than six
3:10
millimeters, but they're usually, you
3:11
know, up to maybe 12 millimeters or so.
3:13
This one is much more dilated
3:15
than that, much more fluid-filled.
3:17
And that is again because
3:18
as they chronically slowly
3:20
process because of this cecal cancer.
© 2024 MRI Online. All Rights Reserved.