title: Adenocarcinoma of the appendix presenting as bilateral ureteric obstruction.
abstract: BACKGROUND
  Adenocarcinoma of the vermiform appendix is a rare neoplasm of the gastrointestinal tract. Presentation mimics acute appendicitis, but right iliac fossa mass and intestinal obstruction have also been reported. These presentations reflect various stages of a locally expanding tumour causing luminal obstruction of appendix. The investigation and subsequent management with a review of the literature is presented.
  
  
  METHODS
  We report a case of appendicular adenocarcinoma found unexpectedly in a 43 year old male who presented with urinary symptoms. Cystoscopy and uretero-renoscopy showed normal bladder but external compression of the ureters and therefore bilateral stents were inserted. CT scan showed a caecal mass. After colonoscopy, that showed external compression, and diagnostic laparoscopy the patient underwent right hemicolectomy. Histopathology revealed well differentiated adenocarcinoma with signet ring morphology with multiple lymph node involvement. The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.
  
  
  CONCLUSIONS
  Patients with atypical manifestations related to right lower abdominal quadrant should be thoroughly investigated with an open mind. Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.
authors.affiliation: Department of General Surgery, St Thomas' Hospital, London, UK. kahmed198@yahoo.co.uk
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
authors.forename: Robiol
authors.initials: R
authors.lastname: Hoque
authors.forename: Sherif
authors.initials: S
authors.lastname: El-Tawil
authors.forename: Mohammad S
authors.initials: MS
authors.lastname: Khan
authors.forename: Mark L
authors.initials: ML
authors.lastname: George
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D001063:Appendiceal Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D017809:Fatal Outcome; D006801:Humans; D007813:Laparotomy; D008297:Male; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology