25/05/2026
A 75-year-old woman presented to the surgical outpatient department with a 4-month history of intermittent abdominal discomfort and progressive abdominal distension. She reported vague, dull pain localized mainly to the lower right side of the abdomen, associated with early satiety and reduced appetite. Over the preceding 2 months, she had unintentionally lost approximately 6 kg. She also complained of occasional nausea, increasing fatigue, and altered bowel habits characterized by intermittent constipation.
On examination, the patient appeared mildly cachectic but remained haemodynamically stable. Abdominal examination demonstrated mild abdominal distension with tenderness localized to the right lower quadrant. A firm palpable mass was appreciated in the right iliac fossa. There were no signs of peritoneal irritation, as rebound tenderness and guarding were absent. Bowel sounds were present and normal on auscultation.
Abdominal ultrasound demonstrated a complex cystic lesion in the right lower abdomen.
Contrast-enhanced CT abdomen and pelvis showed a dilated appendix with irregular wall thickening and surrounding soft tissue changes, raising suspicion for appendiceal neoplasm.
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