Not all patients with right-sided abdominal pain and associated inflammatory signs have acute appendicitis. When the usual surgeon finds unusual pathology coupled with evidences of peritonitis, he naturally inclines toward conservative action. The old adage, "The surgeon should run when the pus runs," is not sound surgical judgment in all cases. When one unexpectedly encounters a perforated lesion of the right colon in a completely unprepared patient, he must consider the possibilities of the pathology involved and the consequences of an inadequate procedure.
Inflammatory lesions of the colon cannot always be distinguished from neoplastic ones. This lack of certainty is admitted by our most experienced surgeons. One must therefore at times base his judgment on probabilities. From a statistical viewpoint one must assume that a perforated right colon lesion is a carcinoma. Although the frequency of cancer of the left colon is emphasized, cancer of the right colon is not
WITKOWSKI LJ, PONTIUS GV, ANDERSON RE. Primary Hemicolectomy for Perforated Lesions of the Right Colon. AMA Arch Surg. 1957;74(5):741–745. doi:10.1001/archsurg.1957.01280110083011