IgG4-Related Disease of the Appendix

Excerpt

A 57-year-old gentleman presented with dull aching pain in the right iliac fossa (RIF) and weight loss for last 4–5 months. There was no history of fever, vomiting, anorexia, gastrointestinal bleed, altered bowel habits, and respiratory or urinary symptoms. Past medical history was not significant except for diabetes. On clinical examination, there was a tender firm mass in RIF. Laboratory investigations revealed the following: hemoglobin, 9.7 g/dL; total leukocyte count, 7.7 K/uL; CRP –145 mg/L; CEA –6.16 ng/ml; and normal renal and liver function tests. Abdominal CT showed a hugely dilated appendix with thickened walls. There was intraluminal fluid density with bubbles of gas and a fecalith inside. The rest of the abdominal organs appeared normal (Fig. 1a). Considering the high possibility of it being a malignant mucocele, we decided to proceed with laparoscopic right hemicolectomy. Intraoperatively, there was a 12 × 8-cm appendiceal tumor with adherent omentum.

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