Acute Appendicitis Due to Metastasis of Prostatic Adenocarci
A 73- year-old man was admitted to the emergency department with right iliac fossa pain for 5 days without nausea, vomiting or fever. His medical history indicated a prostatic adenocarcinoma with multiple bone metastases located in spine, ribs and sternum. Six years ago, the patient underwent an ultrasound-guided needle biopsy after a suspicious digital rectal examination, which yielded a poorly differentiated prostate adenocarcinoma with Gleason score of 7. A radical prostatectomy was performed with a finding of positive regional lymph nodes, associated to doxorubicin, cyclophosphamide chemotherapy, and gonadotropin-releasing hormone therapy administration.

Physical examination revealed rebound tenderness over McBurney’s point. Laboratory tests found leukopenia with a white blood count of 3,700/?L (normal range: 4,000 - 10,000/?L), an elevated C-reactive protein level to 45.5 mg/L (normal range: < 6 mg/L), and no alterations in liver tests and no other significant biological abnormalities were observed. Vital signs were normal. Clinical examination showed pain within deep palpation of the right iliac fossa with rebound tenderness, and the rest of the examination was unremarkable. Contrast-enhanced computed tomography (CT) revealed a dilated appendix with a size of 11 mm in diameter, and a diffuse infiltration of surrounding fat (Fig. 1), and multiple bone metastases are also visible....

http://www.currentsurgery.org/index.php/jcs/article/view/284/237
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