Abstract
Appendiceal cancer is rare and is often diagnosedincidentally in patients undergoing appendectomy for acute appendicitis.However, patients with appendiceal cancer areatincreased risk of synchronousmalignancy.In thiscasereport, wepresent a 58-year-old maninitially diagnosedwith acute appendicitisafter presenting to the emergency department with abdominal pain.He had an appendectomy and was discharged the following day.Unexpectedly, the postoperativehistopathologicexaminationshoweda primaryadenocarcinoma in the appendix.A computed tomographyscan showed rectal wall thickening and the patient wasreferredtocolonoscopy wherean experiencedendoscopistfoundarectaltumorduring thedigitalrectalexaminationprior to the colonoscopy.The tumor was initially missedby thenewlyqualifieddoctorwho examined the patientduringhisfirstadmittancetohospital.The patient's two primary cancers weretreated withalaparoscopic righthemicolectomyfor the appendicealcancerandalowanteriorresectionfor the rectal cancer.Thiscase supports the importance of a full colorectalworkup in patients with appendicealcancer.Italso emphasizes the value of a thoroughdigital rectal examination and the need for improved focus on teaching and practice of the procedure.
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