CLINICAL CHALLENGES AND IMAGES IN GI Cecal Pole Mass Causing Intussusception Karen Chan and Ker-Kan Tan Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore
Question: A 41-year-old woman presented with intermittent, right-sided abdominal pain, abdominal distension, nausea, and vomiting over a 3-month period. Computed tomography (Figure A, B) revealed a tubular structure arising from the terminal ileum protruding into the caecum consistent with ileocolic intussusception. Colonoscopy was subsequently performed and revealed a smooth mass with a possible bluish tinged dimple at the cecal pole (Figure C). The appendix orifice could not be positively identified. The terminal ileum was intubated and there was no mass identified. The patient subsequently underwent a laparoscopic right hemicolectomy where the cecal mass and the appendix were removed intact without any intraoperative perforation (Figure D). The cecal mass was firm to touch and the appendix was markedly swollen. The specimen was cut open and is shown in Figures E and F. What is the diagnosis? Look on page 980 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.
Conflicts of interest The authors disclose no conflicts. © 2014 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2014.06.035
Gastroenterology 2014;147:979–980
CLINICAL CHALLENGES AND IMAGES IN GI Answer to the Clinical Challenges and Images in GI Question: Image 4 (page 979): Low-grade Mucinous Neoplasm of the Appendix The histology of the specimen confirmed the presence of a polypoid mass between the junction of caecum and appendix. The mass was filled with thick, gelatinous mucin and its walls were lined with mucinous epithelium with an undulating architecture. There was little mitotic activity. This was consistent with a final diagnosis of low-grade mucinous neoplasm of the appendix. Appendiceal tumors are very rare and account for
Question: A 41-year-old woman presented with intermittent, right-sided abdominal pain, abdominal distension, nausea, and vomiting over a 3-month period. Computed tomography (Figure A, B) revealed a tubular structure arising from the terminal ileum protruding into the caecum consistent with ileocolic intussusception. Colonoscopy was subsequently performed and revealed a smooth mass with a possible bluish tinged dimple at the cecal pole (Figure C). The appendix orifice could not be positively identified. The terminal ileum was intubated and there was no mass identified. The patient subsequently underwent a laparoscopic right hemicolectomy where the cecal mass and the appendix were removed intact without any intraoperative perforation (Figure D). The cecal mass was firm to touch and the appendix was markedly swollen. The specimen was cut open and is shown in Figures E and F. What is the diagnosis? Look on page 980 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.
Conflicts of interest The authors disclose no conflicts. © 2014 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2014.06.035
Gastroenterology 2014;147:979–980
CLINICAL CHALLENGES AND IMAGES IN GI Answer to the Clinical Challenges and Images in GI Question: Image 4 (page 979): Low-grade Mucinous Neoplasm of the Appendix The histology of the specimen confirmed the presence of a polypoid mass between the junction of caecum and appendix. The mass was filled with thick, gelatinous mucin and its walls were lined with mucinous epithelium with an undulating architecture. There was little mitotic activity. This was consistent with a final diagnosis of low-grade mucinous neoplasm of the appendix. Appendiceal tumors are very rare and account for
