A 14-year-old patient who came to the emergency department complaining of pain in the right lower limb for 5 days, with conserved transit, and afflict fixation, did not report similar episodes of abdominal pain.
On physical examination, the patient had pain in the RIF with resistance and sensation of mass.
Laboratory tests revealed 12,600 leukocytes with 74% neutrophils.
Abdominal ultrasound was reported to be compatible with invagination.
With the intention of endoscopically solving the invagination, the Surgery Department requested a modification.
It was explored until the last centimeters of terminal ileum where there were nodular images that were biopsied.
In the cecum, the inflammatory mucosa showed a rod with aspect and nodularity in its lumen.
Picture was defined as a vesicular orifice without pus exit.
The rest of the colonic mucosa was normal.
Later, an abdominal CT was performed showing thickening of the wall of the terminal ileum at a length of 4 cm. An image of density of soft parts at the level of the ileocecal valve was observed.
a chronic granulomatous lining of the acute abdomen, the uncertain diagnosis and the impossibility of discarding follicular neoplasm; fibrosis was performed a right hemicolectomy in which the cecal appendix markedly thickened with focal lymphocytic hyperplasia
