Cecal Lipoma: A Rare Etiology of Acute Appendicitis in Adults

Acute appendicitis is the most common indication for abdominal surgeries worldwide. Obstruction of the appendiceal orifice is thought to be the primary pathology of appendicitis. The obstruction leads to an increase in the intraluminal pressure resulting in ischemia and inflammatory process. Several pathologies could cause obstruction of the appendix lumen. These pathologies include hard fecal masses, stones, lymphoid hyperplasia, and neoplasia. We present the case of a 42-year-old man who presented to the emergency department with a complaint of abdominal pain and diarrhea for 3 days. The abdominal pain started in the periumbilical region and was shifted to the right lower quadrant of the abdomen. The pain started gradually and had been progressing in severity. He described the pain as a stabbing in nature. Abdominal examination revealed a soft abdomen with diffuse tenderness. However, the tenderness was more pronounced in the right iliac fossa with a positive rebound sign. Further, the Rovsing sign was positive. Initial laboratory investigation revealed elevated leukocyte count and elevated inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein. The CT scan demonstrated well-defined homogenous fat density endoluminal lesion in the cecum with an average size of 6 cm with associated thickened wall appendix. The patient was prepared for an emergency laparoscopy for limited segmental rection of the cecum with appendectomy. Lipoma is a rare benign tumor of the gastrointestinal tract. Clinicians should maintain a high index of suspicion for benign and malignant neoplasms when they encounter patients with suspected acute appendicitis in the adult population.