Burkitt-type lymphoma incidentally found as the cause of acute appendicitis: a case report and review of literature

Background Appendectomy remains one of the most common emergency operations. Recent research supports the treatment of uncomplicated appendicitis with antibiotics alone. While nonoperative management of appendicitis may be safe in some patients, it may result in missed neoplasms. We present a case of acute appendicitis where the final pathology resulted in a diagnosis of a Burkitt-type lymphoma. Case presentation An 18-year-old male presented to the emergency department with 24 h of right lower quadrant pain with associated urinary retention, anorexia, and malaise. Past medical history was significant for intermittent diarrhea and anal fissure. He exhibited focal right lower quadrant tenderness. Workup revealed leukocytosis and CT uncovered acute appendicitis with periappendiceal abscess and no appendicolith. Laparoscopic appendectomy was performed and found acute appendicitis with associated abscess abutting the rectum and bladder. Pathology of the resected appendix reported acute appendicitis with evidence of Burkitt-type lymphoma. A PET scan did not reveal any residual disease. Hematology/oncology was consulted and chemotherapy was initiated with an excellent response. Conclusions Appendiceal lymphomas constitute less than 0.1% of gastrointestinal lymphomas. Primary appendix neoplasms are found in 0.5–1.0% of appendectomy specimens following acute appendicitis. In this case, appendectomy allowed for prompt identification and treatment of an aggressive, rapidly fatal lymphoma resulting in complete remission.

The Best Strategy for Nasogastric Tube Removal in Patients with Acute Appendicitis Complicated with Ileus: A Case Report and Review.

BackgroundAcute appendicitis is one of the most common causes of the acute abdomen. However, acute appendicitis complicated with ileus is uncommon. By presenting this case, we aim to give some suggestions on the postoperative care, especially an algorithm for the insertion and removal of nasogastric tube.Case presentation A 20-year-old man presenting with left lower abdominal pain and symptoms of ileus was diagnosed with acute appendicitis complicated with ileus by computed tomography scan. A nasogastric tube was inserted for the ileus preoperatively. He underwent laparoscopic appendectomy, during which periappendiceal abscess with local peritonitis was noted. The nasogastric tube was removed on the first postoperative day, but symptoms of ileus developed again. Urografin study revealed contrast media retaining in the small bowel, so nasogastric tube reinsertion was performed. The nasogastric tube was removed on the ninth postoperative day after the recovery from ileus. The patient was discharged on the thirteenth postoperative day.ConclusionPatients of acute appendicitis with ileus should be assessed carefully. Nasogastric tubes shouldn’t be removed until the following requirements are satisfied: Firstly, symptoms of abdominal distention and nausea relieve. Secondly, no more hypoactive bowel sounds are found. And finally, nasogastric tube drainage becomes less than 200mL per day, or the passage of flatus or stool presents.

Nail Biting as a Cause of Appendicitis

Ingestion of a foreign body is commonly encountered in clinical practice, but most cause no complications, passing spontaneously through the gastrointestinal tract. However, they can cause obstructive signs and symptoms, and surgical intervention for extraction of the foreign body may be required after identifying its location. We present here the case of a 49-year-old woman who presented to our emergency room with abdominal pain localizing to the right lower quadrant. Evaluation was most consistent with acute appendicitis, and she underwent uncomplicated appendectomy. A keratin nail with Actinomyces was identified in her appendix. Foreign bodies in the appendix can cause simple appendicitis, perforation, periappendiceal abscess, and peritonitis. Regardless of etiology, an appendectomy often ends up the primary treatment, but unusual and rare causes are worth noting if only for the clinician to be aware of when evaluating the next patient with abdominal pain and considering treatment options or future prevention. Our case is an example of a rare scenario in which an Actinomyces-contaminated human nail lodged in the appendix of a woman eventually resulting in acute appendicitis.