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Background
Idiopathic solitary caecal ulcer is uncommon and its presentation may mimic pathologies more commonly encountered in the acute surgical take, such as appendicitis or inflammatory bowel disease (IBD)
Laparoscopy is useful in the emergency setting, particularly when the diagnosis is unclear
Partial caecectomy can easily be performed laparoscopically in cases such as this, thus avoiding the need for laparotomy or more extensive resection
Case presentation
A 21-year-old woman presented to the emergency department with a 24 h history of abdominal pain. The pain was generalised initially, but had localised to the right iliac fossa after several hours. Associated symptoms included anorexia, nausea and several episodes of loose stool. There was no significant medical or family history. Clinical examination revealed tachycardia, and significant right lower quadrant tenderness in the abdomen with signs of localised peritonism.
Investigations
Blood tests showed mildly elevated inflammatory markers with a C reactive protein of 14 mg/L and white cell count of 12.8x109 /L. Ultrasonography of the pelvis demonstrated a large amount of free fluid in the pelvic cavity. The appendix could not be visualised, and the uterus as well as both ovaries imaged normally.
Differential diagnosis
The main differential diagnoses in this case included appendicitis, IBD or pelvic inflammatory disease.
Treatment
Diagnostic laparoscopy was performed for presumed appendicitis. This revealed an abnormal cream-coloured mass of approximately 3x3x3 cm on the anterior surface of the caecum. The appendix appeared normal. Dissection of the mass was started; however, as the mass was noted to be adherent to the anterior surface of the caecum ( figure 1 ), we elected to resect it laparoscopically. Partial or 'sleeve' caecectomy was performed using an endoscopic linear cutter ( figure 2 and video 1 ). Routine laparoscopic appendicectomy was also carried out.
Video 1 'Sleeve' caecectomy for inflammatory caecal lesion media1...