Carcinoma transvers colon with caecal perforation mimicking appendicular lump

Abstract

A 43 year-old female with caecal perforation and localized peritonitis as a result of transverse colon malignant stricture was presented. Initially she was evaluated in two different clinics and treated conservatively as appendicular lump. She was brought to Apollo Hospitals Dhaka as her condition deteriorated. CECT abdomen disclosed an annular soft tissue mass at mid part of transverse colon that completely obstructed the lumen. The colon proximal to the lesion and small bowel were grossly dilated and filled up with fecal matter. On laparotomy, a lump was noted in right iliac fossa which was made of omentum, small bowel and lateral abdominal wall. A perforation was noted in the lateral wall of caecum after dismantling the lump. The colon and the small bowel were decompressed through caecal perforation site peroperatively. Right hemicolectomy and primary anastomosis was performed. Patient survived the operation and she was discharged from hospital on the 10th postoperative day with an advice of regular follow up in surgical OPD. She was referred to Oncology centre for chemotherapy.

In conclusion, any patient around the age of forty or above with features of appendicular lump deserves full work-up including CECT to exclude colonic malignancy. Resection and primary anastomosis may be a preferred procedure for right colonic carcinoma perforation.

DOI: 10.3329/pulse.v3i1.6552

Pulse Vol.3(1) July 2009 p29-30