Patient Presenting With Suspected Appendicitis

Patient Presenting with Suspected Appendicitis -- Appendiceal Carcinoid Tumor

Case

A forty-five-year-old man presented to ER staff with what appeared to be routine appendicitis. He had driven himself to the hospital and was not brought in by ambulance. The patient complained of pain on his right side that was acute and excruciating. He had not previously experienced pain in this area or to this degree, and assumed that he was having an appendicitis attack. He was anxious and nervous about surgery to remove his appendix if it was needed. He had no other medical history other than routine doctor visits and tests, none of which showed a problem. His most recent routine visit was four months ago with his regular doctor, and he had never been hospitalized for anything before, which contributed to his nervousness and worry.

Living alone, he had no family or friends close by to help him through this, and no medical insurance, as he had been laid off from his job and could not afford insurance on his own. He was still looking for work. He was given an MRI to look for anything out of the ordinary and the tumor on his appendix was detected. The decision was made to remove the appendix, after careful determination that the tumor had not metastasized and affected any other areas. After surgery the patient was awake and feeling much better, and would go home after only a couple of days. Other than his concern over the medical bills there were no issues troubling the patient and he was healing on schedule with what would be expected for such a procedure. The tumor on his appendix was very small, and no further problems from it would be expected.

Discussion

Usually this type of tumor is seen in children and young adults, and the incidence of it decreases from there (Safioleas et al., 2005). In people over sixty years old it is almost never seen. However, this is only partially due to the number of appendectomies that are performed on the general public and the fact that fewer people over sixty years of age still retain their appendix (Hemminki & Li, 2001). The other reasons behind it are not well understood or explained. The appendiceal carcinoid tumor is usually innocuous (Kulke & Mayer, 1999). A small tumor, it is often found by accident when the appendix is removed for some other reason. It can, however, contribute to acute appendicitis in rare cases, such as what took place in this case. It is diagnoses in females more frequently than males, but it is believed to be equally prevalent in both sexes (Kulke & Mayer, 1999).

These types of tumors typically invade the lymph system, muscular layers, and the peritoneal area, but they rarely metastasize (Sandor & Modlin, 1998). They can become malignant, but that is even more rare than metastasis. Generally, an appendectomy is the way to treat this tumor and since this is what took place in this case, there is no further cause for concern (Hemminki & Li, 2001). If the tumor becomes very large, however, a right hemicolectomy may be required (Safioleas et al., 2005). This is a rare occurrence that most people with these tumors do not need to concern themselves with.