Cecal adenocarcinoma was confirmed on the surgical specimen.

Acute appendicitis is a very common presentation to ED. The usual cause is some form of luminal obstruction, which is most commonly from a fecolith/appendicolith. Less common causes include parasites (e.g. Ascaris), gallstones and tumor. It is imperative that appendicitis in an older population not be dismissed as once in a while you will come across a case such as this, with an obstructing cecal carcinoma. This also has important implications for the surgeon, who will change the surgical approach (to prepare for a right hemicolectomy) if alerted to the possibility of an underlying tumor.

In staging, CT is still the mainstay modality. For liver metastases however, Primovist MRI is much more sensitive, and its role is more in the detection of small lesions, as this has treatment implications (e.g. resection, ablation or systemic therapy).