2024年 · 第39卷第04期

The patient, a 23-year-old male, was admitted to the hospital on 21-Nov-2022 for "relieving dark red bloody stool for 6 days". In the past, gastroscopy for "melena" 3 years ago revealed "erosive hemorrhagic gastritis". Check on the day of admission: Hemoglobin 150 g/L. Gastroscopy revealed chronic non-atrophic gastritis with bile reflux and no obvious hemorrhagic lesions. Colonoscopy showed dark red liquid and a few blood clots in the intestinal lumen, and no abnormalities were found in the cecum and appendix opening. CT angiography of superior and inferior mesenteric arteries: no obvious abnormalities were found. During hospitalization, melena was repeatedly relieved, and the hemoglobin 100 g/L was re-examined on November 23rd. Enteroscopy: massive blood clots in the cecum with active bleeding at the opening of the appendix. Laparoscopic exploration was performed in the emergency department. During the operation, the appendix was located in the upper position of the cecum, the size was about 10.0 cm ×1.2 cm, and it was obviously enlarged. The mesangium was ligated at the root of the mesangium and the appendix was removed. When the appendix was dissected, blood accumulated in the appendix cavity, and no erosion of the mucosa was seen (Figures 1 and 2). Another intraoperative colonoscopy showed no bleeding from the appendix opening. Postoperative pathological examination showed that the submucosal and subserous parts of the appendix tissue were dilated and congested (Figure 3). After 1 1/2 months of follow-up, there was no further bloody stools.

A 23-year-old male was admitted with "metastatic right lower abdominal pain for 12 h, aggravated with fever for 4 h". There was a history of multiple episodes of appendicitis in the past, all of which were improved by conservative treatment. Physical examination: tenderness in the right lower abdomen, with rebound pain and muscle tension. Blood routine: white blood cells 19.10×10⁹/L, the percentage of neutrophils was 86.3%. Pelvic CT examination revealed the right lower abdominal ileocecal blind tube shadow, about 9 mm in diameter, with thickened tube wall. Admission diagnosis: acute suppurative appendicitis. Laparoscopic appendectomy was performed. During the operation, small intestinal congestion in the right iliac fossa, pus accumulation between intestines, and aneurysm-like dilatation of the appendix were observed. The root was about 2 cm thick and blackened, and the tip was about 5 cm thick and blackened, bleeding when touched (Figure 1). Considering the severe adhesion and bleeding in the surgical area, open appendectomy was performed. Postoperative pathological examination showed that the cancerous tissue was composed of medium to large cells under light microscope, with vacuolated nuclei, irregular chromatin and bichromic cytoplasm (Figure 2). Immunohistochemical examination revealed: CK (−), CD3 (−), CD5 (−), CD20 (+, diffuse) (Figure 3A), IMP3 (+), Ki-67 (+ ~90%) (Figure 3B), ALK (−), CD30 (−), PAX5 (+) (Figure 3C), CD10 (+), BCL-6 (+). Pathological diagnosis: diffuse large B-cell lymphoma, GCB type.