An incidental finding of ANET in a patient with perforated appendix: A case report

Int J Surg Case Rep. 2021 Dec:89:106625. doi: 10.1016/j.ijscr.2021.106625. Epub 2021 Nov 23.

Abstract

Introduction and importance: Appendiceal neuroendocrine tumors (ANETs) are incidentally found in 0.2-0.7% of appendectomies for suspected appendicitis.

Case presentation: A 29-year-old female presented with pain in the right lower quadrant of her abdomen for the past 48 h. On emergency appendectomy for suspected acute appendicitis, a perforated appendix was found. Histopathological examination showed grade 1 (low) ANET.

Clinical discussion: Appendiceal neuroendocrine neoplasms (ANENs) are commonly found at the tip of the appendix and are treated with appendectomy alone. For few ANENs located at the base, or small tumors (≤2 cm) infiltrating the submucosa, the muscularis, the subserosa layer or the mesoappendix, right hemicolectomy is recommended. However, no guidelines have been established concerning patients with appendiceal perforation in case of ANENs.

Conclusion: Although rare, ANETs should be considered in the differential diagnosis of acute appendicitis. Since, ANETs are rarely diagnosed preoperatively, subsequent patient evaluation after appendectomy is crucial for management of the patient.

Keywords: Appendiceal neoplasms; Case report; Neuroendocrine tumor; Perforated appendicitis.