There was no blood in the terminal ileum. After irrigation, active oozing from the appendiceal orifice was seen. Colonoscopy revealed fresh blood in the cecum and right colon. Hemoglobin four months prior to procedure was 12.3 g/dL. We report a case of appendiceal orifice bleeding in a woman with fibrous obliteration of the appendix.Ĭase Description/Methods: A 51 year-old female with fibromyalgia and chronic abdominal pain underwent outpatient colonoscopy to evaluate several months of intermittent hematochezia. Introduction: Appendiceal orifice bleeding is an uncommon etiology of lower gastrointestinal bleeding and is often attributed to various appendix pathologies. David Valadez, MD 1, Alfredo Camero, MD 1, Sarah Hackman, MD 1, Pranav Penninti, DO 2, Juan Echavarria, MD, MSc 1ġUniversity of Texas Health, San Antonio, TX 2University of Texas Health Science Center, San Antonio, TX The treatment of choice is surgical excision of the appendix. Immunohistochemical staining confirms the diagnosis of appendiceal neuroma, where the neoplasm cells are stained with S-100 protein. The process may be confined to the mucosa or may replace the entire lumen. Histopathologically, there was a proliferation of S100-positive nerve tissue. The differential diagnosis of stromal tumors of the appendix includes leiomyoma, gastrointestinal stromal tumors, and neurogenic lesions. Clinically, it is usually an incidental and asymptomatic finding, but it can mimic appendicitis, as in this case. The process typically begins at the distal part and may affect only the tip or even the entire vermiform appendix. Several studies believe it may result from the proliferation of neuroendocrine cells due to frequent inflammatory attacks. An appendiceal neuroma represents an incidental finding in appendices excised for other reasons.
It is usually found in older individuals but is occasionally seen in young patients. The patient had a stable recovery, and she was discharged a few hours later.Īppendiceal neuroma, also referred to as neurogenic hyperplasia, was thoroughly described by Masson over 50 years ago. The final diagnosis was appendiceal neuroma. Most of these cells were positive for S-100 protein ( Fig. The lumen of the appendix's tip was obliterated by a proliferation of spindle cells with wavy nuclei arranged in bundles ( Fig. 2A) with infiltration of polynuclear cells ( Fig. Microscopic examination of the H&E-stained sections showed mild crypt hyperplasia in the appendix's base ( Fig.
#FIBROUS OBLITERATION OF APPENDIX SERIAL#
The external surface of the appendix was grey-white with congested blood vessels, and the lumen of the distal part was absent in serial sections ( Fig. The specimen was sent to the pathology department. A diagnosis of acute appendicitis was made, and an appendectomy was performed. An abdominal ultrasound showed a dilated vermiform appendix in the right lower fossa with a peri-appendiceal fluid collection.
Other routine blood values were within normal limits. Laboratory tests showed white blood cells (6000 mm 3) with neutrophilia (79 %). She had no history of ganglioneuromatosis, neurofibromatosis, or MEN 2B syndrome. The patient was a non-smoker and non-alcoholic. The physical examination revealed localized tenderness by palpation at the right iliac fossa with evidence of rebound. A 76-year-old woman patient presented to the emergency department at Tishreen University Hospital in 2022 with right lower quadrant abdominal severe pain for 4 days.
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