Isolated Diffuse Cavernous Hemangioma of the Appendix with Acute Appendicitis
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IMAGES IN SURGERY
Isolated Diffuse Cavernous Hemangioma of the Appendix with Acute Appendicitis Nabeel Thommil Padinjarenalakath 1 & Sidhic KA 1 & Arunjith Panarukandi 1 & Shanavas Cholakkal 2 Received: 29 September 2020 / Accepted: 22 October 2020 # Association of Surgeons of India 2020
Abstract Cavernous hemangioma of the appendix (CHA) is a rare clinical entity. Since there are only a few case reports on CHA, clinical features, diagnosis, and management of a CHA are not adequately explained in medical literature. A thirty-three-year-old gentleman, hailing from northern Kerala, presented with right lower quadrant pain and nausea of 3-day duration. On clinical examination, he was diagnosed to have acute appendicitis, which was confirmed by ultrasound abdomen. He was planned for laparoscopic appendicectomy. Intra-operatively, he was found to have thick and edematous appendix with multiple elongated and tortuous vessels over the surface, with the rest of the bowel and intra-abdominal organs normal. He underwent laparoscopic appendicectomy, and the final histopathology (HPR) report showed acute appendicitis with diffuse cavernous vascular malformation of the appendix. The postoperative period was uneventful, and the patient was discharged on postoperative day 3. CHA is a rare clinical entity which is difficult to diagnose preoperatively. A laparoscopic approach may be used for both the diagnosis and treatment in CHA. Keywords Cavernous hemangioma of the appendix . Vascular malformation . Appendicitis . Laparoscopic appendicectomy . RIF pain
Introduction Hemangioma of the gastrointestinal tract (GIT) is relatively uncommon and consists of a collection of malformed blood vessels in the GIT [1, 2]. Cavernous hemangioma of the appendix (CHA) is extremely rare in the medical literature [3]. In this article, we report a case of isolated diffuse CHA with acute appendicitis.
Case Presentation A 33-year-old gentleman presented with right iliac fossa (RIF) pain and nausea of 3-day duration. On examination, * Shanavas Cholakkal [email protected] 1
Department of General surgery, MES Medical College, Perinthalmanna, Malappuram, Kerala, India
2
Department of Neurosurgery, Government Medical College, Kozhikode, Kerala, India
the patient was hemodynamically stable with right iliac fossa tenderness and rebound tenderness. On further investigations, he was found to have leukocytosis with neutrophilia. Sonological examination showed RIF probe tenderness with acute appendicitis, hence planned for laparoscopic appendicectomy. Laparoscopy showed a thick and edematous appendix with multiple elongated and tortuous capillaries limited to the appendix, and the patient underwent laparoscopic appendicectomy (Fig. 1). Histopathology showed features of acute appendicitis with diffuse CHA (Fig. 2). Postoperatively, our patient improved symptomatically and was discharged on postoperative day 3.
Discussion Hemangioma of the GIT is usually benign vascular proliferations, sub-classified into capillary, cavernous, and mixed capillary
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