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Sessile serrated adenoma/polyp leading to acute appendicitis with multiple pyogenic liver abscesses: A case report
Koki Sato1, Masataka Banshodani2, Masahiro Nishihara3
1Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Introduction:
Although appendicitis is a common disease, appendicitis concurrent with liver abscesses and sessile serrated adenoma/polyp (SSA/P) is rare.
Presentation Of Case:
A 69-year-old man presented with symptoms of abdominal pain and fever. Computed tomography (CT) revealed multiple liver abscesses and an enlarged appendix with a pseudotumoral appearance, which suggested acute appendicitis. In the emergency operation, ileocecal resection was performed for the perforated appendicitis with an inflammatory mass in the ileocecum. On macroscopic examination, the torose lesion was localized at next to the appendiceal orifice. The tumor was diagnosed as SSA/P based on the microscopic finding. The postoperative course was uneventful, and the liver abscesses were cured by antibiotic therapy. The patient was discharged 17days after the surgery.
Discussion:
In this case, SSA/P localization at next to the appendiceal orifice was suggested as the cause of the perforated appendicitis with multiple liver abscesses. The patient was successfully treated with a combination of surgery and antibiotic therapy.
Conclusion:
This is the first reported case of a patient with SSA/P that led to acute appendicitis with multiple pyogenic liver abscesses.
Insights
A rare case of appendicitis complicated by liver abscesses was caused by a sessile serrated adenoma/polyp (SSA/P). This finding highlights the importance of considering SSA/P in appendicitis cases with unusual complications.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Appendicitis is common, but concurrent appendicitis, liver abscesses, and sessile serrated adenoma/polyp (SSA/P) are rare.
- SSA/P is an important precursor lesion in colorectal cancer, but its association with appendicitis and liver abscesses is not well-documented.
Purpose of the Study:
- To report the first case of SSA/P causing acute appendicitis with multiple pyogenic liver abscesses.
- To discuss the clinical presentation, diagnosis, and management of this rare condition.
Main Methods:
- A 69-year-old male presented with abdominal pain and fever.
- CT scan revealed liver abscesses and appendicitis; emergency ileocecal resection was performed.
- Microscopic examination confirmed SSA/P adjacent to the appendiceal orifice.
Main Results:
- The patient was diagnosed with perforated appendicitis secondary to SSA/P, complicated by multiple liver abscesses.
- Postoperative recovery was uneventful, with abscesses resolving after antibiotic therapy.
- The patient was discharged 17 days after surgery.
Conclusions:
- SSA/P adjacent to the appendiceal orifice was identified as the likely cause of perforated appendicitis and liver abscesses.
- Successful treatment involved a combination of surgical resection and antibiotic therapy.
- This case underscores the potential for SSA/P to cause severe intra-abdominal infections.
