The investigators enrolled patients with colonic LSL [greater than or equal to]20 mm, whereas the exclusion criteria were incomplete snare excision; LSL located at the ileo-cecal valve, appendiceal orifice
, and fully circumferential lesions; and previously attempted LSL.
Our patient did not have concurrent coincidental appendicitis, as the appendiceal orifice
visualized at colonoscopy was normal along with the caecum and terminal ileum, indicating no evidence of inflammatory bowel disease.
(4), an ulcer was detected 1.5 cm from the appendiceal orifice
and a 0.3 cm antimesenteric carcinoid tumor was found in the appendix.
Patient was then transferred under the care of the general surgery department, where he underwent a colonoscopy which demonstrated an extrinsic compression at the caecum and appendiceal orifice
and a smooth pedunculated polyp measuring 10 mm in the sigmoid colon (Figure 2).
CT colonography can reveal abnormalities in the expected position of the appendiceal orifice
such as an intraluminal smooth lesion or caecal contour abnormality .
The diagnosis should also be suspected on colonoscopy in patients with inverted appendices or a bulbous appendiceal orifice
. The investigation of choice in patients suspected with endometriosis is laparoscopy, and if there is appendiceal involvement, an appendicectomy is warranted.
 Colonoscopic findings include the 'volcano sign', the appendiceal orifice
seen in the centre of a firm mound covered by normal mucosa or a yellowish, lipoma-like submucosal mass.
The CT scan revealed an apparent mass causing a filling defect of the cecum near the appendiceal orifice
. A subsequent colonoscopy showed that the appendix was partially intussuscepted, with mucosal thickening at the appendiceal orifice
The cecal wall thickening causes funneling of oral or rectal contrast material within the upper cecum, which points to the obstructed appendiceal orifice
However, colonoscopy revealed an ulcer with submucosal thickening of the cecum near the appendiceal orifice
. A biopsy of this site demonstrated an adenocarcinoma with prominent signet ring cell features.