Surgery MCQ 134

A 25 years old male patient presents with clinical features suggestive of acute appendicitis. At laparotomy he is found to have 2.5 cm growth at the base of appendix. He should be treated with:

A. Appendectomy
B. Right hemicolectomy
C. Appendectomy followed by right hemicolectomy at later stage if the margins are positive
D. Limited illeo-caecal resection

The most appropiate treatment option is:

C. Appendectomy followed by right hemicolectomy at a later stage if the margins are positive

Here's the breakdown of the reasoning:

• Standard Appendicitis Treatment: Appendectomy is the initial and essential procedure for appendicitis, even when a mass is present. This removes the inflamed appendix and addresses the immediate concern.

• Mass Raises Concerns: A 2.5 cm mass at the appendix base is significant and necessitates further evaluation due to the increased risk of malignancy (cancer).

• Pathology Determines Next Steps:  Following the appendectomy, the appendix and the mass will be examined by a pathologist under a microscope. This pathology report will reveal the nature of the mass.

• Negative Margins: If the pathology report shows negative margins,  meaning there are no cancer cells at the edges of the removed tissue, then the appendectomy might be sufficient treatment

• Positive Margins:  If the pathology report shows positive margins, indicating cancer cells are present at the edges, it suggests a higher risk of cancer spread. In this scenario, a right hemicolectomy, which removes the right half of the colon,  might be necessary to ensure complete removal of cancerous tissue.

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