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Abstract: A 51-year-old female patient came to the doctor with symptoms such as pain and fever in the right lower abdomen, and was confirmed to have adenocarcinoma of the appendix by ultrasound, CT, colonoscopy, and pathological examination. The patient was treated with surgery + drug therapy + chemotherapy. After treatment, the lesion was cleared and the symptoms such as right lower abdominal pain, wasting and weakness were effectively controlled. The prognosis is good and there is no sign of recurrence at follow-up.
Basic information】Female, 51 years old
Disease Type】Appendiceal adenocarcinoma
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】April 2021
Treatment plan】Surgical treatment (radical right hemicolectomy, peripheral lymph node dissection) + chemotherapy + drug therapy (pethidine hydrochloride injection, mannitol solution, sulfadiazine tablets)
Treatment period】1 week of surgery hospitalization, 2 years of follow-up
Treatment effect] The lesion was cleared, and the symptoms of right lower abdominal pain, wasting and weakness were effectively controlled.
I. Initial consultation
One afternoon, two women came to the clinic, the older one wasted, with a painful expression and a stooped body, covering her right lower abdomen with both hands, barely walking with assistance. After inquiry, we learned that this was a mother and daughter, and the patient was the older mother, 51 years old, who had unprovoked right lower abdominal pain, intermittent, a month ago, and was seen at a local hospital, where she was given anti-inflammatory treatment (the specific name of the drug is unknown), with mild relief of symptoms. One day ago, the pain in the right lower abdomen worsened and was accompanied by fever, reaching a maximum temperature of 38 degrees, but without abdominal distension or diarrhea. Based on the symptoms and signs, the patient underwent ultrasound, CT, and colonoscopy. The colonoscopy showed a labyrinthine ileocecal flap and an ulcerative lesion was seen in the appendix area. Considering the possibility of cancer, a biopsy pathology was taken from the lesion area and cancer cells were found and the diagnosis was adenocarcinoma of the appendix.
(Pathology report)
II. Treatment process
After admission, considering that the patient was in obvious pain at the time of consultation, pethidine hydrochloride injection was first given to relieve pain and calm the patient. Subsequently, we communicated with the patient’s daughter and decided to use surgical treatment by performing right hemicolectomy, and were admitted to the hospital. When the patient was hospitalized, she had a good attitude, cooperated actively, and improved all relevant preoperative examinations, and no clear contraindication to surgery was seen. Three days before surgery, the intestine was cleaned with mannitol every night and sulfadiazine tablets were used to reduce surgical complications, and a clean enema was given the night before surgery to prepare for surgery. During surgery, the patient’s diseased tissue was completely removed by right hemicolectomy. After surgery, the patient was hospitalized for observation for 1 week, recovered well and had no infection, and could be scheduled for discharge. Adjuvant chemotherapy was arranged for 3 months to prevent and delay tumor recurrence.
III. Treatment effect
After performing right hemicolectomy, the patient’s diseased tissue was removed and peripheral lymph node dissection was also performed. During the subsequent 3 months of chemotherapy, constant monitoring was required to determine whether there was a possibility of tumor recurrence, and the doctor and family members were constantly reassuring and encouraging the patient, but the patient was very happy that the appendiceal adenocarcinoma did not recur again after examination and was discharged. After this treatment, the patient’s right lower abdominal pain was solved, her appetite increased, her weight was restored, and her mental state was greatly improved. After two years of follow-up review, there was no sign of metastasis and recurrence of tumor, and the patient and family were very satisfied.
IV. Notes
Seeing the patient’s happy discharge from the hospital, my heart was also very relieved. Patients with appendiceal adenocarcinoma should pay attention to the detection of symptoms and complications, and before the recovery of intestinal function, parenteral nutrition can be given to promote wound recovery. Prevent irritation to the surgical wound. Eat more fresh vegetables and fruits to reduce the side effects of chemotherapy. Keep a good attitude, and relatives should also give more care and attention to patients to enhance their self-esteem and improve their quality of life.
V. Personal insight
Appendiceal adenocarcinoma is a rare appendiceal disease, a systemic wasting disease, often non-specific and easily misdiagnosed as acute and chronic appendicitis or appendiceal abscess, and pathological biopsy should be performed to clarify the diagnosis. Patients with appendiceal adenocarcinoma need to actively cooperate with doctors to improve healing and prolong life cycle by means of surgical procedures and medical chemotherapy. Patients and their family members should pay more attention to communicate with their doctors in time to stabilize their condition and prevent further deterioration once abnormalities are detected after surgery. As in the case of the patient in this article, who actively cooperated with the treatment and whose family members also gave enough care and had a good attitude, there were no problems with postoperative recovery and follow-up.