Lisa
a teenager from Fiji was visiting our country. A few days after arriving here,
she came to see me complaining of pain on the right side of the lower part of
her belly. Her menstrual periods were regular and her last period was ten days
ago. She was not feeling sick or nauseous and had no temperature. I felt she
may have a small cyst or an egg growing on the right ovary causing her pain. She
had some pain (tenderness) on pressing on the right side, which we call the
appendix point. So the other possibility was appendicitis. But she had no
nausea or fever which often comes with appendicitis. I did an ultrasound of the
pelvis myself. This was normal there was no pelvic pain and the ovarian
follicle (egg) was growing on the left side.
The
egg usually grows only on one side. I gave her some pain relief, reassured her,
and let her go home. The pain persisted for almost six weeks. The family were
not very happy; I decided to do an appendectomy. At the time of the operation
the appendix looked normal. The report on the appendix picked up two shotgun
pellets at the tip of the appendix. They were about five mm each. She had a rabbit
(poor rabbit) for dinner several weeks ago while she was in Fiji. She never had
the pain again after appendectomy. Lesson from this story is always pay
attention to patient’s symptoms
THE O THIS STORY IS SIMILAR BUT NO PELLETS
CARCINOID TUMOUR OF THE APPENDIX
Carcinoids are rare slow growing human
tumours. They rise
from
nerve cells and glands. The common sites for this are the
Gut,
even more common is the appendix. Rarely they form in the lung as well, and not show in this diagram.
R
L
They e They are more common in men. The case I have
described here was of a woman. About 140 cases are diagnosed each year in Victoria.
Tina a 36 year old healthy looking woman came to see me
complaining of pain on the right side of her belly
and this had been going on for last two years.
We call this appendicular point. She had seen
many specialists, a gynaecologist, a physician and a general surgeon. They could
not explain to her why she has this pain. Carcinoid can often be silent. They can
also cause pain, diarrhoea, weight loss and hot flushes as they secrete special
types of hormones for the working of the digestive system .They occur if there
is increased acidity in the gut. She had many investigations, a FBE, electrolytes,
liver function, and an ultrasound including the pelvis and appendix. The pelvic ultrasound showed normal ovaries and uterus no other pelvic pathology was seen.
The appendix showed an indistinct mass in the distal part as shown in the above picture. There was some yellowish
homogenous mass in the lumen. The posterior wall component and periserosal fat
was normal. The finding surely indicated an abnormal appendix probably a
carcinoid. I told her to go back to the surgeon and ask him to remove her appendix
if he was not happy to do this come back to me, and I will do it for her. When he
did it turned out to be a Carcinoid of the appendix. I saw her twice after the
operation with a one year interval.
Repeated the ultrasound and tumour
markers. Tumour markers are recent tests which indicate any tumours in the
body. She has been very well and sends me her friends from far off places for
correct diagnosis and Xmas cards. The lessons for me from these two cases were;
listen to my patients, be attentive and think of rare diagnosis.
