THE HIDDEN APPENDIX; COLONOSCOPIC RESECTION WITH LAPAROSCOPIC ASSISTANCE IN INTRACECAL APPENDICITIS – A CASE REPORT alberto_rrz@hotmail.com

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THE HIDDEN APPENDIX; COLONOSCOPIC RESECTION WITH LAPAROSCOPIC ASSISTANCE IN INTRACECAL APPENDICITIS – A CASE REPORT

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Mexico

Video

Intracecal appendix has an incidence of 0.01%. Only 191 cases of intracecal appendicitis have been reported in the literature.

A 32-year-old primigravida at 27.6 weeks of gestation presented with fetal hypomotility and intrauterine fetal demise due to a septic process. Clinical findings included fever (38.8°C), tachycardia, leukocytosis (22,000/uL), 2% bands, and 86% neutrophils. The pregnancy was terminated surgically, and during intra-abdominal exploration, a firm intracecal tubular structure was found with no external vermiform appendix. A postoperative CT scan revealed a 10 mm thickened tubular image within the cecum. A colonoscopic appendectomy was performed, assisted by single-port laparoscopy for cecal reinforcement with sutures. Histopathology revealed acute appendicitis with a well-differentiated neuroendocrine tumor, multifocal endometriosis, and decidual reaction. The patient was discharged on postoperative day three without complications.

Intracecal appendicitis is more common in pediatric males around 7 years old due to inflammatory pathology. In adults, it is usually associated with endometriosis or mucocele. The main symptom is abdominal pain, often accompanied by vomiting. In 57% of cases, diagnosis is made intraoperatively. No prior cases in pregnant women have been reported in the literature. The most common treatment is reduction and open appendectomy; when this fails, cecotomy or ileocectomy with reconstruction is performed. Colonoscopy is therapeutic in only 3% of cases. Colonoscopic snare appendectomy was first reported in 2006. This is the first reported case using single-port laparoscopic assistance for colonoscopic resection and cecal reinforcement.

Intracecal acute appendicitis is rare and can be managed successfully with a combined colonoscopic and laparoscopic technique

https://vimeo.com/1116295008