Presentation
On and off right lower abdominal pain associated with nausea. No fever, vomiting, or change in bowel habits.
Patient Data
No renal or ureteric calculus is seen. Enlarged appendix measuring about 11 mm in diameter, containing multiple small calcifications in its distal part. No peri-appendiceal fat stranding, free fluid, or collection is seen. Two small gallstones without any CT features of acute cholecystitis. Normal size spleen with a few small linear capsular calcifications.
Interval increase in the size of the appendix forming a convoluted irregular-shaped cystic lesion, measuring 13 mm in diameter proximally and 24 mm distally, likely representing an appendiceal mucocele. Mildly high-density fluid contents (average density=22 Hounsfield units) noted in the appendix. No peri-appendiceal fat stranding or signs of rupture. A small stone in the dependent portion of the gallbladder. Mildly dilated CBD measuring 7 mm, containing a small stone at its distal end. Small focal fat-containing lesion measuring 7 x 10 mm in the uncinate process of the pancreas (pancreatic lipoma).
- histopathology (cholecystectomy): moderate chronic cholecystitis and intraluminal calcular debris.
- histopathology (appendectomy): mucinous cystadenoma of appendix. Negative for invasive malignancy.
Case Discussion
At initial presentation, plain CT pyelogram was done to exclude the clinical suspicion of right ureteric colic which showed an enlarged appendix, suspicious of appendicitis. The patient was discharged against the medical advice at that time and six years later, she presented again with right lower abdominal pain and underwent a follow-up CT scan. After the 2nd CT scan, she underwent laparoscopic cholecystectomy and appendectomy.