PLASTRON OR APPENDICULAR TUMOR?

Abstract

Introduction: The term appendicular plastron is used to describe a palpable appendicular mass that contains the probable inflamed, addictive viscera and the greater omentum, associated or not with the presence of pus.

The management of this entity is controversial. In the case of associated sepsis criteria, the indication is an emergency surgical intervention, otherwise, a conservative treatment can be chosen

The objective of this paper is to present a complex case where a patient with a presumptive diagnosis of appendiceal plastron and failed percutaneous drainage had to undergo exploratory laparotomy and right hemicolectomy.

Clinical case: 65-year-old woman who was admitted due to pain in the right iliac fossa associated with a palpable painful mass, feverish equivalents, weight loss and anorexia of 4 weeks of evolution. An abdominopelvic tomography is performed in which a heterogeneous, poorly defined area is evidenced, associated with collections of various sizes. The picture is interpreted as an appendicular plastron, proceeding to perform percutaneous drainage of the same. Due to poor progression of the condition and the presumption of an underlying neoplastic pathology responsible for the recurrence of the collections, it was decided to perform a right hemicolectomy with primary anastomosis for adequate subsequent evaluation.

Conclusion: The management of the appendicular plastron is controversial. The use of percutaneous drainage has a high rate of effectiveness, although the rate of undetected neoplasms presents a non-negligible percentage. For this reason, an adequate anamnesis is of vital importance, without losing sight of strict follow-up, both clinical and percutaneous drainage, and in the event of a poor evolution, opt for surgical treatment, avoiding interval appendectomies capable of delaying the diagnosis and treatment of oncological pathologies in a timely manner.