Appendiceal-sigmoid adhesion mimicking a colonic polypoid lesion: A case report
This case report describes a rare instance where chronic appendicitis caused an appendiceal-sigmoid adhesion that mimicked a colonic polypoid lesion, highlighting the importance of recognizing a positive non-lifting sign to avoid unnecessary endoscopic resection and guide appropriate surgical management.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine your body as a bustling city where different neighborhoods, like the colon and the appendix, usually keep to their own streets. Sometimes, however, a construction accident or a past injury can cause two buildings to stick together with a sticky, fibrous glue called an adhesion. In the world of medicine, doctors use a long, flexible camera called a colonoscope to peek inside the "colon neighborhood" and look for trouble. Usually, when they see a bump, they assume it's a growth sprouting from the wall itself, like a mushroom on a tree trunk. But what if that bump isn't growing from the wall at all? What if it's just a heavy backpack strapped to the outside of the building, pressing inward so hard it looks like a bump from the inside? This is the tricky puzzle doctors face when they try to tell the difference between a real internal growth and an external push. Getting this wrong is like trying to cut a mushroom off a tree, only to realize you're actually trying to slice through a backpack tied to the bark, which could tear a hole right through the tree.
This paper tells the story of a 42-year-old woman who brought this exact confusion to the hospital. She had been dealing with stomach aches and constipation for four years. When doctors looked inside her colon with a camera, they found a 20 mm bump in her sigmoid colon that looked exactly like a polyp (a growth). They tried to perform a standard procedure called an endoscopic mucosal resection (EMR), which involves injecting fluid under the bump to lift it up like a cushion before cutting it off. But here's the twist: the bump refused to lift. In medical terms, this is called a "positive non-lifting sign." It's like trying to lift a table that is bolted to the floor; no matter how much you push, it won't budge. Because the bump wouldn't lift, the doctors realized it wasn't a simple growth on the inside wall. They stopped the procedure to avoid accidentally poking a hole in the colon.
Since the patient had a history of pelvic surgeries (for an ectopic pregnancy and uterine fibroids), the doctors suspected that scar tissue from those past operations might be the culprit. They decided to perform exploratory laparotomy, which is essentially opening the abdomen to look directly at the organs. Inside, they found the answer: the tip of her appendix was firmly stuck to the outside of her sigmoid colon, creating a tight, fibrous tether. The "polyp" the camera saw was actually the appendix pressing against the colon from the outside, creating a fake bump. The appendix itself was inflamed (chronic appendicitis) and covered in scar tissue. Once the surgeons carefully cut the appendix free and removed the adhesions, the "bump" disappeared, and the patient's symptoms vanished completely.
The paper highlights a crucial lesson for doctors: just because something looks like a polyp inside the colon, it doesn't mean it is a polyp. Sometimes, external forces like adhesions from past surgeries can masquerade as internal growths. The authors suggest that when a doctor sees a lesion that won't lift during an endoscopy, they should immediately suspect that the problem might be coming from outside the colon wall, not from within. By stopping the endoscopic attempt and moving to surgery, they avoided a dangerous perforation and correctly identified the issue as a chronic appendicitis with adhesions, rather than a dangerous tumor. This case serves as a reminder that the human body is full of surprises, and sometimes the most obvious-looking problem is actually a trick of perspective caused by things sticking together where they shouldn't.
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