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Cecal Cancer Causing Appendicitis

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0:01

So, another patient presenting with right

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lower quadrant pain that's not necessarily

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an appendicitis in this particular case.

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Again, following that colon

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down till we reach the cecum.

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You can already spot it over here that

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there's an inflamed, thickened, fluid-

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filled tubular structure with lots of

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inflammation and lymph nodes around it.

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But always keep things in order if you can.

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And so I continue to follow that cecum down

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and now we see where the

0:26

structure is arising from.

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This is the appendix.

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But it does look a little bit different

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than all the other cases that I showed you.

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If you put a measurement on it, this is easily

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going to be, you know, 16 to 20 millimeters.

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This is way larger than that 6-

0:40

millimeter cutoff that we usually use.

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There's a lot of inflammation and there's a

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whole lot of lymph nodes, which we generally

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don't see with an acute appendicitis

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because it's happening so quickly.

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So in a case like this, when it's this dilated

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and this fluid-filled, you want to stop and

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take a second to think, could this be something

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else that's causing an acute appendicitis?

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So I would agree, we do have an

1:00

acute appendicitis here, that-

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appendix is absolutely wildly abnormal.

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It is inflamed, it's thickened, it's enhancing.

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But we're looking for an obstructed

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region right here, reason right here.

1:12

And you can see here in the cecum, the

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cecum itself is thick-walled and enhancing.

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And this to me is more than

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just reactive cecal thickening.

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Reacting to that acute appendicitis.

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This itself is the abnormality.

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And that would also explain

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why we have lymph nodes here.

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So you could say, is this an

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inflammatory process of the cecum?

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And I would argue that it's not because the

1:31

inflammation is centered around the appendix.

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It is not centered around the cecum.

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So we do not have, you know, focal colitis

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that's also causing an acute appendicitis,

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but we do have lymph nodes and lymph nodes

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imply something more chronic is going on here.

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So in a case like this, I would be most

1:47

concerned for a cecal cancer that's

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obstructing and causing acute appendicitis.

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And in particular, in my experience

1:54

with cases like these, the cecal cancer

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is not an acute obstructive process.

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It's more of a chronic, ongoing thing.

2:00

So it obstructs it very slowly,

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which allows that cecum to dilate.

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much more than you would see in a

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normal acute appendicitis, which

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is a relatively acute obstruction.

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And so in these cases, that appendix

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will be allowed to get way, way, way

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bigger until it finally becomes an

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inflamed, um, potentially perforates.

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So in this case, the operation is the same.

2:20

They need an operation immediately.

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But it's really good for the surgeon to

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have an idea ahead of time that they may

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be doing a partial colectomy in this case,

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maybe they would get a different surgeon,

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you know, colorectal surgeon to come in,

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but it's good to know that ahead of time.

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So potentially have the patient have

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one operation instead of one for the

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acute appendicitis and a second to

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come back and do a hemicolectomy.

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So it is really useful to the surgeon

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to know that you might suspect that

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there's an underlying cecal mass

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causing this acute appendicitis.

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So again, just to recap.

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The, the salient findings in a

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case like this, you'll see abnormal

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cecal thickening enhancement.

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You may see lymph nodes that may be

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from the cancer itself because this

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is a more chronic process that's

3:00

resulting in this acute appendicitis.

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And then finally, the appendix

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itself will be more dilated than it

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normally is in acute appendicitis.

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Those, again, will be greater than six

3:10

millimeters, but they're usually, you

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know, up to maybe 12 millimeters or so.

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This one is much more dilated

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than that, much more fluid-filled.

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And that is again because

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as they chronically slowly

3:20

process because of this cecal cancer.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Neoplastic

Infectious

Gastrointestinal (GI)

CT

Body

Appendix

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