Perforated appendicitis and obstructing colonic carcinoma in the elderly

Area of Science:

• Gastroenterology
• Surgical Oncology

Background:

• Appendicitis is commonly caused by luminal obstruction from various lesions.
• Colonic neoplasms are an uncommon but significant cause of appendicitis, particularly in older adults.

Observation:

• Two cases of perforated appendicitis associated with obstructing colonic cancers are presented.
• A 75-year-old male developed a fecal fistula post-appendectomy, revealing hepatic flexure carcinoma.
• A 62-year-old male had occult blood in stool post-appendectomy, leading to diagnosis of sigmoid carcinoma.

Findings:

• Appendicitis can be a presenting symptom of obstructive colonic carcinoma.
• Approximately 3% of appendicitis cases in patients over 40 involve colonic carcinomas.
• Delayed diagnosis of colonic cancer can occur if appendicitis is the initial clinical presentation.

Implications:

• Clinicians should consider colonic neoplasms in elderly patients presenting with appendicitis.
• Enhanced diagnostic workup, including colonoscopy, is warranted in specific appendicitis patient populations.
• Early detection of colonic cancer improves patient outcomes and survival rates.