An Unusual Culprit Behind Right Lower Quadrant Pain: Cecal Adenocarcinoma Initially Suspected as Appendicitis in an...

This case report addresses an unusual etiology of right lower quadrant (RLQ) abdominal pain in an elderly patient. While acute appendicitis is a common surgical emergency, especially among young people, older patients may exhibit atypical symptoms that conceal a more severe pathology. The main objective of this article is to highlight the diagnostic challenges and therapeutic implications of cecal adenocarcinoma that mimics acute appendicitis. We describe the clinical presentation, diagnostic workup, intraoperative findings, and postoperative course of a 74-year-old female patient who had symptoms compatible with acute appendicitis. Despite preoperative imaging indicating appendicitis, the surgical investigation revealed a cecal tumor, prompting a right hemicolectomy. The initial investigation revealed localized RLQ pain and leukocytosis, along with elevated C-reactive protein (CRP). Imaging studies indicated retrocecal inflammation and cecal distention. The intraoperative evaluation revealed a grossly normal appendix but a firm cecal mass. A right hemicolectomy was performed. Histopathology revealed a moderately differentiated cecal adenocarcinoma classified as pT3N0Mx. The patient's recovery went smoothly, and she was discharged on postoperative day 7 with an oncology referral. Cecal carcinoma can manifest as acute appendicitis in elderly patients, necessitating a high level of suspicion and careful intraoperative evaluation. Prompt conversion to definitive oncologic surgery, as proven, enables correct diagnosis and timely treatment. Surgeons should be extra cautious, especially in patients over 40, and perform appropriate postoperative screening in search of underlying malignancies.