Complicated Pelvic Appendicitis Presenting as a Pelvic Pseudotumoral Mass with Intraoperative Suspicion of Gynecological Malignancy: A Case Report

Abstract

Pelvic appendicitis is an uncommon anatomical variant that may create significant diagnostic challenges because of its proximity to gynecological, urinary, and colorectal structures. In elderly women, delayed diagnosis may lead to perforation, abscess formation, and inflammatory extension to adjacent organs, occasionally mimicking pelvic malignancy. We report the case of a 72-year-old woman who presented with prolonged right lower quadrant pain associated with vomiting, diarrhea, intermittent fever, and deterioration of general condition. Laboratory investigations revealed severe inflammatory syndrome and anemia. Contrast-enhanced computed tomography demonstrated a large multiloculated pelvic abscess of probable appendiceal origin with significant compression of adjacent pelvic structures. Surgical exploration was initially performed laparoscopically but required conversion to laparotomy because of dense inflammatory adhesions. Intraoperative findings revealed a retro-uterine abscess, severe pelvic appendicitis, uterine perforation, parametrial infiltration, and suspicious pelvic lymphadenopathy, raising concern for gynecological malignancy. Retrograde appendectomy, subtotal hysterectomy, peritoneal lavage, pelvic drainage, and biopsies were performed. Histopathological examination demonstrated extensive suppurative inflammation without evidence of malignancy. The postoperative course was favorable, and the patient remained asymptomatic at follow-up. This case highlights the diagnostic complexity of complicated pelvic appendicitis and demonstrates how severe inflammatory disease may mimic gynecological cancer both radiologically and intraoperatively. Histopathological analysis remains essential for definitive diagnosis.