STORIES OF THE APPENDIX

               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.

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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.