Case is a 35 years old male who presented to Surgery OPD for pain in right lower abdomen (on & off) for last 02 months and burning sensation of epigastrium for last 02 weeks. There was no other associated symptoms except for nausea and loss of appetite. He had history of similar pain 02 months ago, for which he was admitted and treated in the line of appendicular lump.
On examination, vitals were unremarkable.
Per-abdominal examination findings were, soft with no distension and a vague lump of approximately 05 x 04 cm in right iliac fossa, which was tender on palpation with local guarding and rebound tenderness.
Blood investigations were unremarkable.
Transabdominal ultrasonography was suggestive of appendicular abscess with perforation & a left renal calculus.
Chest/Abdominal X-Rays were negative for pneumoperitoneum.
He was admitted in male surgery ward and Ocshner-scherren regime initiated. Gradually he showed improvement in terms of settling pain and decreased lump size after 10 days of therapy. Vague lump later turned into discrete lump of approximately 02 x 02 cm which was palpable per abdominally and non-tender.
Repeat transabdominal ultrasonography showed 08 mm appendicular diameter.
Open appendectomy under spinal anaesthesia was planned and executed. Intraoperative findings were a firm lump of 02 x 02 cm in middle one-third of appendix and appendicular tip adhesion with omentum. Other findings were unremarkable. A 02 cm margin of mesoappendix was also excised along with appendix. Intra-operative findings were suggestive of appendicular fecolith.
Histopathological examination of the specimen revealed Low-grade Appendiceal Mucinous Neoplasm (LAMN), pTNM: pT4aN0M0 (Stage IIB, AJCC 8th Edition).
Histological grade was G1 and well differentiated. No lympho-vascular and peri-neuron invasion. Proximal margin was free of tumor with a distance of 2.7 cm from LAMN and mesenteric margin was also free of tumor with a distance of 1.8 cm from LAMN. Additional finding was a diverticula at distal appendix with greatest dimension of 0.5 cm.
Looking at his intraoperative and histopathological findings, we considered that simple appendectomy alone would suffice his treatment.
Postoperatively he recovered well and was discharged on 04th post-operative day.
He came for follow up after 03 weeks of discharge. He was doing well without any signs of complications till then. He was suggested for regular follow ups.