This is an interesting but not uncomon case, particularly in the younger population. Most cases are indeed benign and usually due to inflammatory causes e.g. abscess from the appendicitis itself, associated inflammatory bowel disease, worms in certains parts of the globe, and occasional diverticulitis. There is several good reasons to perform an resection:

1) Provides pathological diagnosis of the unknown mass

2) If the tissue is inflammed, it may compromise the healing of your appendiceal stump

3) If the mass left untreated, it can precipitate subsequent small bowel obstruction

4) And very occasionally the diagnosis is malignant which will significantly change the patient's subsequent treatment, And a delay in diagnosis in this situation will be unsatisfactory. We had a patient who was diagnosed of angiosarcoma presenting with a appendiceal mass: Small intestinal angiosarcoma masquerading as an appendiceal abscess, Ann R Coll Surg Engl. 2013 Jan;95(1):e22-4. doi: 10.1308/003588413X13511609955373

Depending on comfort and expertise, ileocaecal resection should suffice, otherwise right hemi is fine too

Another relevant reference: Inflammatory cecal masses in patients presenting with appendicitis World J Surg. 1999 Jul;23(7):713-6; discussion 716

Hope this helps

= The least that a tumor mass will eventuate is to  mechanically obstruct. You were correct in resecting. 

This is an interesting but not uncomon case, particularly in the younger population. Most cases are indeed benign and usually due to inflammatory causes e.g. abscess from the appendicitis itself, associated inflammatory bowel disease, worms in certains parts of the globe, and occasional diverticulitis. There is several good reasons to perform an resection:

1) Provides pathological diagnosis of the unknown mass

2) If the tissue is inflammed, it may compromise the healing of your appendiceal stump

3) If the mass left untreated, it can precipitate subsequent small bowel obstruction

4) And very occasionally the diagnosis is malignant which will significantly change the patient's subsequent treatment, And a delay in diagnosis in this situation will be unsatisfactory. We had a patient who was diagnosed of angiosarcoma presenting with a appendiceal mass: Small intestinal angiosarcoma masquerading as an appendiceal abscess, Ann R Coll Surg Engl. 2013 Jan;95(1):e22-4. doi: 10.1308/003588413X13511609955373

Depending on comfort and expertise, ileocaecal resection should suffice, otherwise right hemi is fine too

Another relevant reference: Inflammatory cecal masses in patients presenting with appendicitis World J Surg. 1999 Jul;23(7):713-6; discussion 716

Hope this helps

This problem seems conflicting but based on above answers it needs resection ( benign or malignant ) the main problem is extent of resection. In emergent situations such appendectomy in which frozen section is not available easily  , right hemicolectomy is justifiable avoiding reoperation in malignant cases.

Best regards

u did the right thing,right hemicolectomy is the answer. as such no guideline is there as the treatment of the situation is obvious. however, acute appendicitis in elderly or if lum is palpable or clinically suspicious,then it is better do a cross sectional imaging.

I do agree that R hmiicolectomy is the answer.If the mass would have been felt preop,pt requires cect and colonoscopy.

No, your procedure was not right. You should have done a frozen section. Or alternatively a caecectomy.

I also agree with your decision during the operation. After the operation, maybe your pathologist could`nt find any signses of (Esosinophilic entropathy) in the appendix. If you did only an appendectomy. You and your patient would have been all the time in custody.

Dear Cordelia Howitt 

Thank you for your answer but is it possible to take a frozen section in your hospital in a week end  midnight ?

@Cordelia Howitt: frozen section is not available in many centre. Moreover, frozen section may not be conclusive. 

As a surgeon, you are trained to evaluate a "gross" specimen and possible regional extentions if any. .  Many operating hospitals do not have frozen section availability.  Even  with available histopathologist and telecommunication, the embedding and freezing results in tissue distorsion which may not be suitable for a definitive diagnosis with which you will be  basing  your  type and extent of resection.

@Francisco T Tirol: i agree with you. even  frozen section won't help you. right hemicolectomy is the only option whether u perform frozen or not / facility for frozen avail or not.

Surgery Depto - Division of Coloproctology - Ribeirão Preto -SP.

I agree with the other collegues, except if the major suspicion is Crohn's disease, that can be assess by clinical data ( Background history and physical examination). At laparotomy if it seems granulomatosis by Chron"s disease I suggest not touched but treated pharmacologically before. Excision can evolve to fistulas and peritonitis.

        If I may,  herein lies the need for mandatory gross pathology training for surgeons. The expertise gained  can, in many instances, surpass and preempt  a tenuous frozen section exercise (whether available or not).  The diagnostic acumen  of a trained surgeon to differentiate benign tumescence from malignant change, skip areas, etc. should be a given and an "arms length"  expertise to guide him through the "temple of surprises", the abdomen,  in exercising surgical judgement  and executing his surgical skills..  You did well, Doctor Muhammadhosseini.   

Your procedure was right for several reasons

first: the diagnostic of your case is unusual. You have not to manage disease with exception

second: the only alternative in this setting was a ileocaecal resection. The morbidity mortalité and functionnal discorder are similar between ileocaecal resection and right colectomy. So you procédure had no consequence

third: the most important reason is that a frequent diagnostic of cæcal mass is a cancer. 

It depends on how one has approached appendix. I use small incisions for appendectomy and would not do any further steps.Ideal would be to do a later Ba enema or colonoscopy with biopsy. In Asia, we have to think the possibility of Ileocaecal Tb as a cause of  mass. Incidentally, in my career I came across 4 such cases in an Young patient with appendicitis. USG was not available at that time.

Refer to recent publication with photograph  of cecocolic mass, 2.5 cm hypertrophic  thick wall, benign, secondary to chronic recurrent torsion with spontaneous resolution:Congenital Hyperrotated Colon, F.T.Tirol, Abdominal Surgery, Winter/Spring, 2015, Figure 12.