Presentation
Right lower quadrant pain for one day, associated with an episode of vomiting. No fever, altered bowel habits or urinary symptoms.
Patient Data
enlarged appendix measuring about 12 mm in diameter, associated with mild fat stranding around it. No radiopaque appendicolith is seen. No free fluid or collection is seen in the RIF.
incidental finding of a small well-defined partially calcified small bowel related mass lesion measuring about 2 x 2.5 cm, in the left iliac fossa. No signs of bowel obstruction or perforation noted.
no radiopaque renal or ureteric calculi or hydroureteronephrosis is seen.
mild degenerative changes at L5-S1 intervertebral disc.
Histopathology revealed acute appendicitis. Small bowel related lesion turned out to be a low-grade GIST.
Case Discussion
A clinical diagnosis of acute appendicitis Versus right ureteric colic was made by the emergency department physician and a plain CT pyelogram was requested, which was negative for any ureteric calculus or hydroureteronephrosis. However, the CT scan was positive for acute appendicitis. In addition, the CT scan also showed a partially calcified small bowel related mass lesion in the left iliac fossa which was thought to be a leiomyoma or gastrointestinal stromal tumor (GIST).
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