Incidence of right-sided colonic tumors (non-appendiceal) in patient's ≥ 40 years of age presenting with features of acute appendicitis

Abstract

INTRODUCTION:

Non-appendiceal tumors can mimic and present with clinical features of acute appendicitis in patients of age 40 year or above. The aim of this prospective study is to investigate the incidence of right-sided (non-appendiceal) colonic tumors in patients presenting with clinical features of acute appendicitis.

METHODS:

A prospective data analysis of 1,662 patients using appendectomy database was performed from 2005-2011. Patients above age 40 years or older were included. Patients were compared for demographic data, clinical presentation, radiological findings, operative technique & findings, histo-pathological findings and postoperative complications. The primary outcome was incidence of right-sided colonic (non-appendiceal) tumors presenting with features of acute appendicitis. Secondary outcomes measured were, role of diagnostic radiology, negative appendectomy rate, length of stay and changing trends in operative techniques.

RESULTS:

From 1662 patients initially reviewed, only 179 patients (10.77%) age 40 years or above mean (56 ±11.75), median 54 (40 - 89), with clinical features of acute appendicitis were included in the final analysis. F:M ratio was (1:1.06). CT scan showed in only 1 patient (1.25%, OR=0.806, p=0.695), suspicion of caecal tumour and underwent right hemicolectomy. Histological examination of specimen showed, 2 patients (1.11%, OR=1.10, p=0.47) had primary appendiceal tumors, in which one patient was histologically reported as appendiceal mucocele (mucinous cystadenoma with low-grade dysplasia), while the other one had appendeceal carcinoid (Goblet cell carcinoid). In the other tumor group one patient had metastatic involvement of appendix from ovarian tumor. The time to appendectomy in radiological group was delayed by (9.2±3.7hrs). 131 (73.1%) had laparoscopic while 48 (26.81%) underwent open appendectomy. The negative appendectomy rate was (1.12%) and 30 days complication rate was (11.73%, p=0.27). Mean length of stay was 3.54 ± 2.1 days.

CONCLUSION:

Right-sided colonic (caecal) tumors rarely present with features of acute appendicitis. Only those patients with atypical presentation and findings should have pre- operative radiological evaluation.