Appendiceal endometriosis is a rare form of extragenital endometriosis that can mimic acute appendicitis. This reports presents the case of a 19-year-old woman with no significant medical history who presented with right-sided abdominal pain, nausea, and lightheadedness. Physical examination revealed right lower quadrant tenderness and a positive Rovsing sign. Laboratory studies showed no leukocytosis, and her modified Alvarado score was 4. Computed tomography of the abdomen and pelvis demonstrated mild fluid and inflammatory changes near the base of the cecum extending toward the right adnexa, raising concern for acute appendicitis versus a ruptured ovarian cyst. Pelvic ultrasound identified a complex cystic structure in the right ovary with adjacent free fluid, while appendicitis could not be excluded. Due to persistent symptoms and diagnostic uncertainty, laparoscopic appendectomy was performed. Intraoperative findings included hemoperitoneum, endometriotic lesions, and possible rupture of a right ovarian follicle. Histopathological examination revealed appendiceal serosal endometriosis. This case underscores the diagnostic challenge of appendiceal endometriosis and the importance of considering gynecologic etiologies in young women presenting with right lower quadrant pain.

The primary cause of acute appendicitis is obstruction of the proximal lumen of the appendix, although the underlying etiology remains unclear in many cases. Trauma is a rare but documented cause of appendicitis. We present the case of a 38-year-old man who developed right lower quadrant abdominal pain four days after jumping from the second floor of a department store. He reported no prior episode of lower abdominal pain. Abdominal computer tomography (CT) confirmed the diagnosis of acute appendicitis, and the patient subsequently underwent an emergency appendectomy. This case report and literature review highlight the importance of promptly considering appendicitis in patients presenting with acute abdominal pain following abdominal trauma and underscore the need for timely evaluation and appropriate management.

Appendiceal mucocele is an uncommon clinical and radiological finding characterized by cystic dilatation of the appendix due to intraluminal mucin accumulation and may be associated with underlying epithelial mucinous neoplasms. We present the case of a 45-year-old man with obesity who presented with a four-month history of intermittent right-lower-quadrant abdominal pain, occasional abdominal distension, and nonspecific changes in bowel habits. Physical examination revealed localized tenderness without signs of peritoneal irritation, and laboratory findings were within normal limits. Abdominal ultrasonography demonstrated a cystic tubular structure in the right iliac fossa. Contrast-enhanced computed tomography of the abdomen and pelvis showed a dilated appendix measuring approximately 22 mm in diameter, with homogeneous low-attenuation intraluminal content, wall thickening, and mural calcification, without radiological evidence of perforation, abscess, ascites, or invasion of adjacent structures. Based on these findings, an appendiceal mucocele without radiological signs of complication was suspected. Because the lesion was closely associated with the cecal region and limited appendectomy was considered unsafe due to the risk of rupture or incomplete gross resection, the patient underwent elective open right hemicolectomy with stapled ileotransverse anastomosis. Careful surgical handling was performed to avoid appendiceal rupture and mucin spillage. The postoperative course was uneventful. Histopathological examination confirmed a low-grade appendiceal mucinous neoplasm (LAMN) measuring 10 cm in length and 2.2 cm in diameter, with an uninvolved appendiceal base and no extra-appendiceal mucin, microscopic perforation, invasive adenocarcinoma, or high-grade malignant features. This case highlights the importance of multidisciplinary assessment and risk-adapted follow-up in patients with suspected appendiceal mucinous lesions.

Appendicitis-associated suppurative pylephlebitis with superior mesenteric vein (SMV) thrombosis is an uncommon but clinically important complication that can be identified on contrast-enhanced computed tomography. A 47-year-old man presented with seven days of right lower quadrant abdominal pain, leukocytosis, and elevated inflammatory markers. Contrast-enhanced abdominopelvic CT demonstrated acute appendicitis without CT signs of perforation or bowel ischemia, together with occlusive thrombosis of the superior mesenteric vein extending into mesenteric venous branches. The patient underwent diagnostic laparoscopy with conversion to open appendectomy for source control, followed by broad-spectrum antibiotics and anticoagulation. Follow-up CT 10 days later demonstrated persistent SMV thrombosis and a new postoperative abscess in the appendiceal bed. A subsequent CT five days later showed an interval decrease in the abscess size but progression of thrombus to the origin of the portal vein. This case highlights the importance of systematic evaluation of the portomesenteric venous system on CT in patients with appendicitis and the value of serial imaging for detecting thrombus progression and postoperative septic complications that may directly affect management and prognosis.

Pulmonary pleomorphic carcinoma (PC) is a rare and aggressive subtype of sarcomatoid carcinoma. It is characterized by poorly differentiated cells with both epithelial and mesenchymal features and often presents as a peripheral lung mass. Metastasis to the gastrointestinal tract is exceedingly rare. We report the unusual case of an 87-year-old man with a prior history of lung adenocarcinoma who presented with abdominal pain secondary to a small bowel obstruction. Imaging revealed a right lower quadrant mass, and surgical exploration uncovered an undifferentiated malignant tumor involving the small bowel mesentery. Histopathological analysis demonstrated spindle cells, giant cells, and rhabdoid features with positive immunostaining for thyroid transcription factor-1 (TTF-1), Napsin A, and CK7, consistent with metastatic PC. Additional imaging revealed widespread disease including masses in the gastrohepatic region, adrenal gland, and sacrum. This case highlights a rare manifestation of pulmonary PC with metastasis to the small bowel causing obstruction, an uncommon but important differential diagnosis in lung cancer patients presenting with abdominal symptoms. Early recognition is critical, as atypical metastatic patterns may delay diagnosis and impact clinical management.

Pneumonia is a common acute respiratory infection that affects the alveoli and distal airways and typically presents with symptoms such as chest pain, cough, dyspnea, and fever. However, it can also manifest with nonspecific symptoms like abdominal pain. This case report presents a previously healthy 24-year-old male who initially presented with severe right upper quadrant abdominal pain and fever. Despite initial treatment, the patient's condition worsened, with the emergence of dyspnea and productive cough. Subsequent examination and imaging revealed community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae. The diagnosis was confirmed through clinical examination, chest X-ray showing a right lower lobe infiltrate, and sputum analysis. The patient was successfully treated with intravenous fluoroquinolone and oral antibiotics upon discharge. This case underscores the importance of considering CAP in the differential diagnosis of acute abdominal pain to avoid misdiagnosis and ensure timely treatment. It highlights the need for awareness of atypical presentations of CAP.

Appendiceal neuroendocrine tumors are the most common primary neoplasms of the appendix and are frequently diagnosed incidentally following appendectomy performed for suspected acute appendicitis. We present a case of a 72-year-old woman with a history of hypertension and hypothyroidism who presented with a 24-h history of right lower quadrant abdominal pain associated with nausea and low-grade fever. Non-contrast abdominal computed tomography demonstrated findings consistent with acute appendicitis. An urgent open appendectomy was performed, and intraoperative findings revealed complicated appendicitis with pelvic inflammatory fluid, fibrinopurulent exudates, and distal appendiceal necrosis. Histopathological examination demonstrated a well-differentiated appendiceal neuroendocrine tumor (NET G1, WHO grade 1), with negative surgical margins, absence of lymphovascular invasion, and a mitotic index of less than 1/mm², associated with acute suppurative appendicitis. Given the favorable histopathological findings, no complementary right hemicolectomy was performed, and the patient was managed with clinical follow-up. The postoperative course was uneventful, with oral intake initiated on postoperative day one, diet advancement on day two, and hospital discharge on day three. This case highlights the importance of routine histopathological examination of all appendectomy specimens and reviews current considerations for risk stratification and therapeutic decision-making in patients with appendiceal neuroendocrine tumors.

Abdominoplasty is a commonly performed body-contouring procedure with a predictable postoperative course. Early abdominal pain is typically attributed to surgical site discomfort, edema, rectus plication, or common complications such as seroma or hematoma. However, intra-abdominal pathology may present with overlapping or nonspecific symptoms, increasing the risk of diagnostic delay. We report two cases of postoperative abdominal pain following abdominoplasty in which intra-abdominal etiologies were identified or strongly considered. In Case 1, a 71-year-old woman with prior Roux-en-Y gastric bypass developed progressive abdominal pain and obstructive symptoms on postoperative day 1. Imaging revealed small bowel obstruction, and diagnostic laparoscopy confirmed an internal hernia through a Petersen's defect requiring surgical intervention. In Case 2, a 34-year-old woman presented with progressive right lower quadrant pain and swelling after a combined reduction mammaplasty and abdominoplasty. Imaging demonstrated an incidental ovarian hemorrhagic cyst, and she was managed conservatively with resolution of symptoms. In both cases, the abdominal wall and surgical sites were clinically benign. These cases highlight that postoperative abdominal pain after abdominoplasty is not always attributable to the abdominal wall or operative field. Overlapping symptoms may contribute to diagnostic anchoring and delayed recognition of intra-abdominal pathology. Maintaining a broad differential diagnosis, particularly in patients with prior abdominal surgery or atypical symptom progression, is essential. Prompt evaluation and multidisciplinary collaboration can reduce morbidity and prevent delays in care.

Ectopic pregnancy (EP) is a commonly seen, potentially life-threatening condition that can be challenging to diagnose in the emergency department (ED) setting. A retroperitoneal EP is an extremely rare condition, with a limited number of reported cases. Because of this, many emergency medicine physicians may not be familiar with presenting symptoms of a retroperitoneal EP. Rupture of an EP is a life-threatening complication that must be diagnosed quickly to reduce the risk of mortality. We present a 27-year-old female who presented with a two-day history of progressive right lower quadrant abdominal pain, nausea, and vomiting. ED evaluation revealed tachycardia of 140 beats per minute, and laboratory assessment was positive for leukocytosis of 27,030 k/uL and a positive qualitative human chorionic gonadotropin. The initial concern was for appendicitis versus ruptured ectopic pregnancy. Point-of-care ultrasound was negative for both intrauterine pregnancy and intraperitoneal fluid. However, there were heterogeneous contents within the pelvis of unclear etiology. Obstetrics was consulted, admitted the patient, and obtained a formal abdominal ultrasound to evaluate her appendix. The radiologist reported a 12 cm pelvic mass for which the differential diagnosis included a uterine fibroid, ectopic pregnancy, or appendicitis. The patient was taken to the operating room for a diagnostic laparoscopy and laparotomy and was diagnosed with a ruptured retroperitoneal EP. She underwent evacuation of the retroperitoneal hematoma and right salpingo-oophorectomy. She was discharged home on postoperative day four.

A woman in her late 60s presented with right lower quadrant abdominal pain suggestive of acute appendicitis. Cross-sectional imaging demonstrated a dilated, fluid-filled appendix with mural enhancement, interpreted as concerning for appendiceal mucocele. Laparoscopic appendectomy was performed. Histopathologic examination revealed goblet cell adenocarcinoma invading into the subserosa (pT3) with involvement of the proximal resection margin. Completion right hemicolectomy was subsequently undertaken for definitive oncologic management and lymph node staging and revealed no residual carcinoma, with nine negative lymph nodes. Postoperative staging imaging showed no evidence of metastatic disease, and the patient was managed with oncologic surveillance. This case highlights the diagnostic limitation of imaging in differentiating appendiceal mucocele from invasive malignancy and underscores the importance of histopathologic evaluation and appropriate oncologic resection in goblet cell adenocarcinoma.