Cuenco, Nicole Jane Z.

BSN-IV
CAPP-2
Task no. 2
Case Scenario:

-A 15 old year-old teenage boy is admitted to the hospital with severe stomach pains and
possible rupture appendix. He complains of severe pain in right lower quadrant for almost two
weeks and took aspirin and mefenamic acid, experienced fever, nausea and vomiting and
constipation too. Diagnostic evaluation tested and recommended for surgical procedure of the
appendix.

I. INTRODUCTION AND OBJECTIVES

Abdominal pain is a common presenting symptom for patients seeking care at

emergency departments, with approximately 3.4 million expected cases per year in the United
States.  Appendicitis is a frequent cause of abdominal pain and occurs in approximately 8 to 10
percent of the population over a lifetime. Appendicitis has its highest incidence between the
ages of 10 and 30 years. The ratio of incidence in men and women is 3:2 through the mid-20s
and then equalizes after age 30. Appendicitis is the most common abdominal surgical
emergency, with over 250,000 appendectomies performed annually in the United States. The
risk of acute appendicitis in pregnant women is not much lower than that of the general
population, making appendicitis the most common nonobstetric emergency during pregnancy.
Untreated appendicitis can lead to perforation of the appendix, which typically occurs within 24
to 48 hours of the onset of symptoms.  Perforation of the appendix can cause intra-abdominal
infection, sepsis, intraperitoneal abscesses, and rarely death. In order to avoid the sequelae of
perforated appendicitis, a low percentage of “negative” appendectomies (i.e., removing a normal
noninflamed appendix in patients mistakenly diagnosed with appendicitis) is generally accepted
from a surgical standpoint.
Clinical symptoms and signs suggestive of appendicitis include a history of central
abdominal pain migrating to the right lower quadrant (RLQ), anorexia, fever, and
nausea/vomiting. On examination, RLQ tenderness, along with “classical” signs of peritoneal
irritation (e.g., rebound tenderness, guarding, rigidity, referred pain), may be present. Other
signs (e.g., the psoas or obturator signs) may help the clinician localize the inflamed appendix.
According to Q Ma, J Wu - International Journal of Gynecological Pathology (2019),
Metastatic tumors of the appendix are rare. Endometrial cancer tends to metastasize by directly
invading neighboring structures; the lung, liver, bones, and brain are common sites of distant
metastasis. Herein, we present a case of a solitary endometrial metastatic tumor in the
appendiceal mucosa without serosal involvement that mimicked a primary adenocarcinoma of
the appendix. The patient who had undergone a radical hysterectomy for an endometrioid
adenocarcinoma 3 years earlier presented to the hospital with a history of persistent right-lower
abdominal pain. Physical examination showed tension of the abdominal muscles, tenderness,
and rebounding pain on the McBurney’s point. Open appendectomy for suspected appendicitis
revealed a perforation of the distal appendiceal tip. Opening of the surgical specimen showed a
mass that was located in the mucosa of the appendix near the appendicular root and resembled
a primary tumor of the appendix. Microscopically, the adenocarcinoma of the appendiceal
mucosa showed a transitional relationship with the normal mucosa, involving the submucosa
and muscle but not invading the serosa. Based on the patient’s medical history and the results
of immunohistochemical staining, we made a diagnosis of metastatic endometrioid
adenocarcinoma. The gross anatomy and histologic features of solitary metastatic tumors can
mimic those of primary tumors. A correct diagnosis should be made by combining the patient’s
medical history with morphologic and immunohistochemical test results.

GENERAL OBJECTIVES:
SPECIFIC OBJECTIVES: