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Appendicitis masquerading as tumor: a case of two diagnoses
M T Marshall1, P Rosen, R Berlin
1Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California, USA.
The Journal of Emergency Medicine
|December 1, 2001
Summary
A large retroperitoneal lipoma can displace abdominal organs, leading to atypical appendicitis presentation. Computed tomography (CT) scans are crucial for diagnosing such complex abdominal pain cases.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Surgical Pathology
Background:
- Acute appendicitis diagnosis can be challenging, especially with atypical presentations.
- Retroperitoneal masses are rare and can cause significant abdominal symptoms.
Observation:
- A 47-year-old male presented with right upper quadrant abdominal pain and tenderness.
- Initial computed tomography (CT) scan revealed a large retroperitoneal lipoma but no clear appendicitis.
- The patient's pain persisted, necessitating surgical consultation and exploration.
Findings:
- Surgery revealed a massive retroperitoneal lipoma compressing abdominal contents, including the cecum and appendix.
- Acute appendicitis was confirmed intraoperatively.
- Retrospective CT analysis showed the appendix atypically located in the epigastrium due to mass effect.
Implications:
- This case highlights the diagnostic utility of CT scans in complex abdominal pain, even with unusual presentations.
- Large retroperitoneal masses can mimic or obscure other intra-abdominal pathologies like appendicitis.
- Awareness of atypical appendicitis presentations secondary to extrinsic compression is vital for accurate diagnosis and timely intervention.
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