present this case then choes releated to the case intersting topic to discuse sapported by guidlines and strong studays . 64 years old male KCO DM presented to the ER with C\O lower right lower quadrant abdominal pain that started one week ago Associated with mild disurea no nausea or voiting no fever no other complaint , PMH DM , PSH Nil allergy Unknown , OE Conscious alert oriented , HD stable afebrail abdomen soft with Righ with right lower quadrant tenderness + ve rebound tenderness , labs WBC 17 hb 11.7 cr urea wNR , CT scan abdomen and pelvis reported complicated rapture acute appendicitis A\W pnemopertoneuom and adjacent reactionary thickening of the sigmoid and cecum .patient was admitted ,kept NPO , started on IVF 125ml\hr RL , started on rocephin + flagyl and under went in same day diagnostic lap + appendectomy +laproscopic Hartmanunder procedure under GA , surgical finding was sigmoid was adhesion to the cecum and the ominous with a cavity mixed with stool and pus 50cc , large perforated distal sigmoid mass around 6*5 cm , reactionary inflammatory appendix with un healthy cecum , no peritoneal deposit or liver nodule identify , post op hospital course was uneventful , and patient discharged home , histopathology shows adenocarcinoma of the sigmoid , 12 LN was negative , 4 deposit ,omental ulceration , granulation tissue formation and fat necrosis appendix extensive serial and transmural inflammation
present this case then choes releated to the case intersting topic to discuse sapported by guidlines and strong studays .
64 years old male KCO DM presented to the ER with C\O lower right lower quadrant abdominal pain that started one week ago Associated with mild disurea no nausea or voiting no fever no other complaint , PMH DM , PSH Nil allergy Unknown , OE Conscious alert oriented , HD stable afebrail abdomen soft with Righ with right lower quadrant tenderness + ve rebound tenderness , labs WBC 17 hb 11.7 cr urea wNR , CT scan abdomen and pelvis reported complicated rapture acute appendicitis A\W pnemopertoneuom and adjacent reactionary thickening of the sigmoid and cecum .patient was admitted ,kept NPO , started on IVF 125ml\hr RL , started on rocephin + flagyl and under went in same day diagnostic lap + appendectomy +laproscopic Hartmanunder procedure under GA , surgical finding was sigmoid was adhesion to the cecum and the ominous with a cavity mixed with stool and pus 50cc , large perforated distal sigmoid mass around 6*5 cm , reactionary inflammatory appendix with un healthy cecum , no peritoneal deposit or liver nodule identify , post op hospital course was uneventful , and patient discharged home , histopathology shows adenocarcinoma of the sigmoid , 12 LN was negative , 4 deposit ,omental ulceration , granulation tissue formation and fat necrosis appendix extensive serial and transmural inflammation
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This case presentation discusses a 64-year-old man with diabetes presenting with right lower quadrant pain. CT scans indicated pneumoperitoneum and suspected appendicitis, but laparoscopy revealed a perforated sigmoid mass. The diagnostic reasoning involved differentiating between appendicitis and perforated colorectal cancer, leading to emergency surgery with an appendectomy and Hartmann procedure. Pathology confirmed adenocarcinoma with negative nodes. The discussion emphasizes the...