Appendiceal adenocarcinoma presenting as fresh bleeding in rectum: Rare case reported

Appendiceal adenocarcinoma is very rare form of cancer. In the US, it has been reported in 1 or 2 people per 1 million per year. However, recent studies show that appendiceal cancer is becoming more common. A case study by Baijaeek Sain and their team have reported fresh bleeding in rectum in cases of primary appendical adenocarcinoma. The case study has been published in International Journal of Surgery Case Reports.

The objective of the study was to evaluate the occurrence of the rare cancer at the primary stage which presented fresh bleeding in the rectum. Incidence of cancer though accounts less than 6% of appendiceal neoplastic lesions and less than 0.5% of all gastrointestinal malignancies. It is mostly diagnosed as an incidental finding after appendicectomy hence its crucial for diagnosing the pathology.

The researchers conducted a case study on an 81 year old male patient who presented with bleeding per rectum in a background of previous rectal polyp, hypertension, diabetes and hypothyroidism. CECT of whole abdomen findings revealed thickening at the appendix and base of the caecum. Colonoscopy showed a sessile polypoid growth at appendicular orifice, at the base of the caecum. Laparoscopy confirmed the clinical suspicion of appendicular carcinoma and laparoscopy assisted radical right hemicolectomy was performed. Final histopathology revealed well differentiated adenocarcinoma of the appendix with no lymph node involvement (pT3N0M0).

The researchers stated that Patients with primary adenocarcinoma of the appendix presented with features similar to acute appendicitis whereas ones with anaemia or fresh bleeding per rectum was a rare presentation. Surgery is the main landmark of the treatment, however they mentioned the extent of it entirely depends upon the stage. Tumours staged as T1 may be managed by appendicectomy alone proved that the base was free and there were no lymphadenopathies. T2 or above stages required right hemicolectomy as chances of lymph node metastasis were high. Nodal involvement warrants the need for adjuvant chemotherapy. Distant metastasis to the peritoneum or liver and lungs are very rare.

The investigators concluded that "While investigating unexplained anaemia or bleeding per rectum, full colonoscopic examination up to the appendicular orifice is important and if required, should be combined with CT scan of abdomen, to clinch the rare but possible and potentially curable diagnosis of appendicular carcinoma." Care must be taken and elderly people presenting with symptoms of acute appendicitis should raise the suspicion of appendicular malignancy.

For further information: Baijaeek Sain, Arnab Gupta, Samir Bhattacharya, Radha Raman Mondal, Sudip Haldar, ShravastiRoy. "Primary adenocarcinoma of the appendix presenting with fresh bleeding per rectum: A case report" International Journal of Surgery Case Reports 86 (2021) 106285.