A 60-year old man with no past medical history presented to the Emergency Department complaining of having abdominal pain and diarrhea for the last ten days. Physical examination and laboratory studies were suggestive of acute appendicitis. The patient was admitted urgently and taken to the operating room. The appendix had signs of acute inflammation and was removed while the small and large intestines were examined thoroughly. Intraoperatively, a necrotic tumor was found on the wall of the sigmoid colon. We removed a part of the sigmoid colon (about 15 cm), and performed Hartmann procedure. During the following days, all the blood markers of inflammatory response returned to normal.
The pathology report showed signs of acute appendicitis and acute diverticulitis of the resected part of the sigmoid, without signs of malignancy.
The surgeon should not forget that the sigmoid colon often has the tendency to move towards the right side of the abdomen and he should therefore consider the possibility of a combination of appendiceal and colonic pathology.