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March 20, 1987

A 73-Year-Old Woman With Abdominal Pain in the Right Lower Quadrant

JAMA. 1987;257(11):1513-1514. doi:10.1001/jama.1987.03390110089033

History  A 73-year-old woman presented with a sixday history of abdominal pain that had started in the epigastrium, but recently had become more intense in the right lower quadrant. She denied experiencing nausea, vomiting, diarrhea, or gastrointestinal bleeding. Peptic ulcer had been diagnosed three years prior to presentation and had been managed medically. Hysterectomy and left oophorectomy had been performed in the remote past. On physical examination, epigastric tenderness as well as guarding and rebound tenderness in the right lower quadrant were present. Mild leukocytosis was reported. Computed tomography (CT) of the abdomen was performed (Figure).Computed tomography demonstrated a 5-cm retrocecal mass with low attenuation (fluid content) surrounded by an irregularly thickened uncalcified wall (Figure). Multiple areas of tissue debris were seen extending into the mass, but no true septation was present. No other abnormality was observed in the abdomen or pelvis.

Diagnosis  Malignant appendiceal mucocele with acute inflammation.