Isolated submucosal lipomatosis of the appendix

Case contributed by Dr Yair Glick

Presentation

Right abdominal pain, elevated CRP.

Patient Data

Age: 55 years

Retrocecal appendix thickened up to a diameter of 9 mm, with long segment of submucosal lipomatosis. Minimal periappendiceal fat stranding.

Case Discussion

The patient was taken to the ER, where an inflamed vermiform appendix was removed laparoscopically.

Isolated appendiceal lipomatosis is a rare entity that can visually mimic appendicitis 1 because of its thickened, hypodense submucosa. One should note the submucosa exhibits fat density, not "water" density. In this specific case, there were appropriate clinical signs, elevated C-reactive protein, and mild fat stranding, all concerning for appendicitis.

Surgical report:
Long retrocecal appendix with signs of acute inflammation, stuck to the abdominal wall.

Pathology report:
Appendix 7 cm long and up to 10 mm in diameter. The serosa is gray and displays vascular markings.

Microscopic description:
Fibro-adipose obliteration.

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Case information

rID: 89448
Published: 8th Jun 2021
Last edited: 2nd Aug 2021
Inclusion in quiz mode: Included
Institution: Laniado Hospital

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