Case Report: The importance of examining colon and rectum in patients with appendiceal cancer [version 1; peer review: awaiting peer review]: The importance of examining colon and rectum in patients with appendiceal cancer

Appendiceal cancer is rare and is often diagnosed incidentally in
patients undergoing appendectomy for acute appendicitis. However,
patients with appendiceal cancer are at increased risk of
synchronous malignancy. In this case report, we present a 58-year-old
man initially diagnosed with acute appendicitis after presenting to the
emergency department with abdominal pain. He had an
appendectomy and was discharged the following day. Unexpectedly,
the postoperative histopathologic examination showed a
primary adenocarcinoma in the appendix. A computed
tomography scan showed rectal wall thickening and the patient
was referred to colonoscopy where an
experienced endoscopist found a rectal tumor during
the digital rectal examination prior to the colonoscopy. The tumor was
initially missed by the newly qualified doctor who examined the
patient during his first admittance to hospital. The patient’s two
primary cancers were treated with a laparoscopic
right hemicolectomy for the
appendiceal cancer and a low anterior resection for the rectal
cancer. This case supports the importance of a full colorectal workup
in patients with appendiceal cancer. It also emphasizes the value of a
thorough digital rectal examination and the need for improved focus
on teaching and practice of the procedure.