Year 2023 / Volume 115 / Number 12
Digestive Diseases Image
A case of an inverted appendiceal stump with dysplastic mucosa mimicking cecal polyp managed by a combined endoscopic laparoscopic approach

715-716

DOI: 10.17235/reed.2022.9237/2022

Branko Bakula, Zeljka Belosic Halle, Dinko Bekic, Andrija Karacic,

Abstract
Endoscopic finding of invaginated appendiceal stump mimicking polyp is very rare. We present a case of patient with appendiceal stump mimicking cecal polyp covered with dysplastic mucosa which makes it even more rare. Polypoid lesions involving the appendiceal area represent a specific diagnostic-therapeutic dilemma. In these situations simple colonoscopic polypectomy poses increased risk for perforation. In our case biopsy of the polypoid cecal lesion revealed dysplastic mucosa. Due to the non-lifting sign and increased risk of perforation from simple polypectomy, polyp was removed by cecal wedge resection using combined endoscopic laparoscopic approach. Histopathology of the specimen confirmed medium dysplastic epithelium covering lymphoid follicles specific for appendix. In our case, decision on the need to remove the polyp, based on biopsy histology, was quite clear; however, the question is what should we have done if the biopsy finding was negative? In such a situation, conservative approach with endoscopic follow-up of the polyp and regular biopsy specimen analysis, or a more active approach of polyp removal should be considered. This issue can be discussed, however, we do believe that decision on approaching such patients should be made individually, based on the patient's age, comorbidities, general condition and operative risk.
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References
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Bakula B, Belosic Halle Z, Bekic D, Karacic A. A case of an inverted appendiceal stump with dysplastic mucosa mimicking cecal polyp managed by a combined endoscopic laparoscopic approach. 9237/2022


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Publication history

Received: 27/09/2022

Accepted: 05/10/2022

Online First: 20/10/2022

Published: 12/12/2023

Article Online First time: 23 days

Article editing time: 441 days


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