Vascular lesion of the appendix causing torsion: A case report

Laparoscopic appendectomy is a common procedure for pediatric surgeons, primarily employed for acute appendicitis. However, this case report presents a unique scenario of a 12-year-old male with symptoms suggestive of appendicitis, diagnosed with an appendiceal mass causing torsion, due to a vascular malformation or reactive vascular proliferation. A 12-year-old male presented with three days of abdominal pain, diarrhea, and emesis. The clinical exam was concerning for appendicitis. Ultrasonography revealed a mildly dilated appendix terminating in a hypervascular, lobulated mass, suggestive of a large solid appendiceal neoplasm. Subsequent CT scan further characterized this lesion that encased the mildly dilated appendix, compressing it and causing reactive appendiceal wall thickening. All laboratory studies were within normal limits. Diagnostic laparoscopy revealed a torsed, hemorrhagic mass originating from the distal aspect of the appendix. He underwent laparoscopic appendectomy, and the entire specimen was removed intact. Pathology reported a non-malignant vascular malformation or reactive vascular proliferation. The patient had an uncomplicated postoperative course and was managed like a standard postoperative appendectomy. One year following this procedure, he was readmitted with a large abdominal mass found to be Burkitt's lymphoma and was started on treatment. Pathology from the original appendiceal resection was reviewed and confirmed to be unrelated. Vascular malformation/proliferation of the appendix is rare and may present similarly to appendicitis. Any mass may serve as a lead point for appendiceal torsion. Simple appendectomy is likely sufficient for such vascular lesions, and many pediatric appendiceal neoplasms.