Evola Giuseppe, Caruso Giovambattista, Caramma Sebastiano, Dapri Giovanni, Spampinato Carmela, Reina Carlo, Reina Giuseppe Angelo
General and Emergency Surgery Department, Garibaldi Hospital, Catania, Italy.
General Surgery Department, San Salvatore Hospital, Paternò, Catania, Italy.
Int J Surg Case Rep. 2019;61:60-63. doi: 10.1016/j.ijscr.2019.06.061. Epub 2019 Jul 16.
Tubulo-villous adenoma is a rare benign appendiceal neoplasm often asymptomatic with the most clinical manifestation that resembles acute appendicitis. Pre-operative diagnosis is difficult by its rarity and the absence of typical symptoms. Adequate treatment is surgical resection.
A 69-year-old male was admitted to the Emergency Department with a two-day history of abdominal pain associated with constipation. Abdominal examination revealed abdominal pain localized, at deep palpation, in the right iliac fossa and in hypogastrium without obvious muscle guarding or rebound tenderness. Laboratory tests showed a normal white blood cell count with 82.3% neutrophils and high C-reactive protein level. After a negative abdominal ecography, the patient was evaluated by abdominal computed tomography, which revealed acute appendicitis. The patient was submitted to surgery and open appendectomy was performed. The post-operative course was uneventful and the patient was discharged on the 5 post-operative day.
Acute appendicitis may be a clinical manifestation of a benign appendiceal neoplasm. Pre-operative radiological investigations not always are useful for an early diagnosis that is mandatory because of the potential risk of malignant degeneration. Appropriate treatment of acute appendicitis is debated: some surgeons suggest operative treatment, but others advocate for non-operative management. In our case the patient was submitted to surgery avoiding the risk of diagnostic delay of neoplasm.
Appendiceal tubulo-villous adenoma is a rare neoplasm difficult to diagnose and suspect because of lack of pathognomonic symptoms and specific diagnostic signs. Acute appendicitis is the most common clinical presentation. Appendectomy is the appropriate treatment.
管状绒毛状腺瘤是一种罕见的阑尾良性肿瘤，通常无症状，最常见的临床表现类似于急性阑尾炎。由于其罕见性和缺乏典型症状，术前诊断困难。充分的治疗方法是手术切除。
一名69岁男性因腹痛伴便秘两天入住急诊科。腹部检查发现，深部触诊时腹痛局限于右下腹和下腹部，无明显肌紧张或反跳痛。实验室检查显示白细胞计数正常，中性粒细胞占82.3%，C反应蛋白水平升高。腹部超声检查结果为阴性后，患者接受了腹部计算机断层扫描评估，结果显示为急性阑尾炎。患者接受了手术，进行了开放式阑尾切除术。术后过程顺利，患者于术后第5天出院。
急性阑尾炎可能是阑尾良性肿瘤的一种临床表现。术前影像学检查并非总能有助于早期诊断，而早期诊断由于存在恶性变的潜在风险是必不可少的。对于急性阑尾炎的适当治疗存在争议：一些外科医生建议手术治疗，但另一些人主张非手术治疗。在我们的病例中，患者接受了手术，避免了肿瘤诊断延迟的风险。
阑尾管状绒毛状腺瘤是一种罕见的肿瘤，由于缺乏特征性症状和特定的诊断体征，难以诊断和怀疑。急性阑尾炎是最常见的临床表现。阑尾切除术是适当的治疗方法。
