A case of completely resected cecum cancer with synchronous metastases to the small intestine found in acute appendicitis.

Purpose: Risk of malignant tumors increase with age;hence, careful examination of older patients should be consdiered when identifying the causes of acute appendicitis. Here, we report a case of a patient with cecum cancer with synchronous metastases to the small intestine that was found during acute appendicitis.

Case report: A 74-year-old man presented with right lower abdominal pain. Physical examination revealed deep tenderness at McBurney's point. Enhanced computed tomography scan showed an abscess around the enlarged appendix and a thickened cecum wall. Colonoscopy revealed a type 2 tumor in the ileocecal region, and pathological examination of the biopsied specimen revealed adenocarcinoma. Microscopic findings revealed two type 2 tumors in the small intestine, pathologically diagnosed as cecum cancer metastases. The final diagnosis was acute appendicitis caused by cecum cancer with synchronous metastases to the small intestine, pStage ⅣB pT4bN1aM1b. The patient received adjuvant chemotherapy and has currently been disease-free for 24 months.

Conclusions: In prolonged appendicitis among older adults, the possibility of malignancy should be considered during preoperative examination and prior to selecting a treatment plan. Delays in the diagnosis of colorectal cancer and metastases may lead to missed opportunities for complete resection and poor prognosis. J. Med. Invest. 71 : 293-297, August, 2024.