Benign cecal lesions associated with appendicitis

Abstract

Three types of radiologic evidence of abnormalities of the cecum may be noted following appendectomy: (1) the ring-shadow of the inverted appendiceal stump, (2) the nipple-like defect of the non-inverted appendiceal stump and (3) defects associated with adhesions. However, polypoid lesions of the cecum cannot be differentiated from the ring-shadow of the inverted stump in all cases. If the diagnosis is not certain, exploration and biopsy should be performed. If lymphadenopathy is present and the diagnosis is in doubt, resection of the ascending colon is probably the safest procedure. The nipple-like defect should not be confused with any other lesion. If symptoms are associated with lesions compatible with adhesions, the latter should be freed. Three cases are presented: one of granulomatous appendicitis treated by appendectomy; the second of adhesions from the internal inguinal ring to the appendiceal base, treated by lysis of the adhesions; and the third, a silk stitch granuloma of the appendiceal stump, associated with a palpable mass and regional adenopathy, and treated by resection of the ascending colon.