A team headed by DR. IMRAN SHAIKH, consultant Surgical Gastroenterology, HPB surgery, and GI Oncosurgery, Wockhardt Hospital, Mira Road, helped a 62-year-old man successfully undergo Radical Right Hemicolectomy with Right Paracolic Peritonectomy to remove the right half of the colon and lymph node along with the right paracolic peritoneum. Right paracolic peritoneum is a layer of the sheet which covers all organs in the abdomen as well as the abdominal wall. This particular layer was involved due to appendix cancer which was ruptured and got adherent to this, as he was suffering from appendicular cancer. It is extremely rare to have appendix cancer in appendicectomy specimen (Incidence is 0.1 – 0.2 %). Only 0.1 % incidence in the world reported to date. Thus, it is important in cancer, to give adequate and timely treatment for a better outcome.
Life was beautiful, until a 62-year-old Mr. Mahindra Patel (name changed) residing at Mira road and retired from self-employed business encountered abdominal pain and vomiting, and presented to the emergency department of Wockhardt hospital, April 2020. A CT scan done on an immediate basis revealed that there is a perforated Appendix with mass formation. Knowing this as a surgical emergency, Dr. Imran Shaikh performed laparoscopic surgery on the patient. The appendix was removed and the infection was drained. The patient recovered in 3 days and was discharged.
Dr. Imran Shaikh, consultant Surgical Gastro, and GI Oncosurgery, Wockhardt Hospital, Mira Road, said, “After 7 days when the patient’s appendix histopathology report came, it showed a mucinous type of cancer. Appendix cancer, also known as appendiceal cancer is a type of cancer that grows in the appendix. The appendix can be described as a pouch-like tube that is attached to the cecum, which is the first section of the large intestine or colon. (Less than 1 %) have it, and considering its type and acute presentation it is a rarest rare case. This patient has a mucinous type of tumor and it has got a bad prognosis as compared to other types of appendicular tumors. There is no definitive cause for appendicular cancer but chronic recurrent infections of the appendix can be predisposing for such condition. There is no way this type of cancer diagnosed before surgery and mostly they see on the pathology report. That’s the exact reason we send all organs after surgery for testing so as to diagnose such rare scenarios.”
Dr. Shaikh added, “This patient has to undergo Radical Right Hemicolectomy with Right Paracolic Peritonectomy includes removal of the right half of the colon and lymph nodes. Because appendix was perforated and the lump was adherent to the right parietal wall of the abdomen it was necessary to add Right paracolic peritonectomy. The surgery took around 3 hours and 30 minutes and minimal blood loss. The patient recovered well and discharged after 7 days. This time his pathology reported being early-stage cancer with no residual disease. After surgery within two weeks, the patient went back to his original life and restarted his daily activity. This was the first case in this hospital in the last more than 5 years. Surgery was performed during COVID 19 pandemic time and his pre-op COVID 19 test was negative. We do take a lot of measures to avoid COVID infection to patients and healthcare workers like doing first emergency surgery with all PPEs in dedicated COVID OT and also managed his first three days of hospitalization in isolation wards which are equipped to take care and avoid spreading COVID infection. We also did a preop COVID 19 test before the second major surgery. We also avoided laparoscopic surgery for the second time in view of international reports from china and North America saying an increase in corona infection with the use of laparoscopy.
“My family and I were disheartened after we got to know that I suffer from rare cancer. I was hesitant to undergo surgery due to the fear of contracting COVID-19. But, the doctors at the hospital took good care of me and offered the best treatment I am eager to start the second innings of my life, with a bang,” concluded the patient Mr. Mahendra Patel (name changed)
The patient was accompanied by his son and daughter in law as it was corona time (only one relative was allowed with patient). The patient was followed after 14 days for suture removal. His wound healed well. He was advised dietary modifications. Medical oncologist opinion was taken and suggested 6 monthly follow up. People should not get bogged down, and instead, have faith that they will beat all the obstacles coming their way.