Ligneus caecitis: A Granulomatous inflammation mimicking malignancy

Abstract

Introduction: Ligneous caecitis is a term given to granulomatous lesions of the caecum which tend to mimic malignancy in their clinical presentation. It usually occurs in a setting of chronic appendicitis. Case presentation: A 52-year-old man presented to a tertiary hospital with abdominal pain and bilious vomiting of 3 months duration. The abdominal pain was in the right iliac fossa, colicky in nature. He had on and off episodes of abdominal distension and vomiting and took symptomatic treatment at a local hospital. He had significant weight loss of 10 kg over a 3 months period. General physical examination was unremarkable. Clinically he had non-tender, vague, firm to hard mass in the right iliac fossa and lumbar region with an irregular surface. The mass was approximately 5x4 cm and non-mobile. Colonoscopy showed a 3 cm nodular appearing mucosa in the ascending colon, with an infiltrative look, and a hard feel on biopsy. The biopsy was negative for malignancy. Computed tomography of the abdomen showed a heterogeneously enhancing irregular circumferential wall thickening involving the caecum, proximal ascending colon, ileocaecal junction and approximately 6cm of the terminal ileum with engorgement of the mesenteric vasculature adjacent to the lesion and enlarged pericolic lymph nodes suggestive of malignancy. Patient underwent a right radical hemicolectomy. Final pathological impression of ligneous caecitis secondary to ruptured retrocaecal appendicitis was imparted. Postoperative period was uneventful. Conclusion: Ligneous caecitis, a rare disease has a clinical resemblance to malignancy of the caecum. The condition presents as large bowel obstruction, with the presence of a palpable mass in the right iliac fossa. It is important for the clinician to be aware of such a condition, thereby reducing the need of more radical surgeries which are usually reserved for malignancies.