Case report of an inverted appendicitis mimicking colon cancer

Inverted appendicitis is a rare surgical event, which mostly leads to the wrong pre-operative diagnosis. Nevertheless, the therapy is usually correct. In case of clinical acute appendicitis, we usually proceed to surgery without further examinations. We report about a 65-year-old woman who presented with abdominal pain for 4 days and typical pain at the McBurney's point. Blood examination showed only a slight elevation of the C-reactive protein with 4.62 mg/dl. The ultrasound strengthened the suspicion of acute appendicitis. Laparoscopy was performed, and a severe purulent pericaecal infection was detected, but the appendix was absent. However, the caecum had typical palpatory aspects of cancer. Consequently, we converted to laparotomy and performed a radical right hemicolectomy. The pathology report revealed the inverted appendicitis without any signs of malignancy. It remains difficult to make the correct pre-operative diagnosis. The type of treatment has to be chosen individually.