Goblet Cell Carcinoid Presenting as Appendicitis 1.5 Years After a Normal CT Scan

A 60-year-old man presented to the emergency room for a second time within one week for a two-week history of intense lower quadrant abdominal pain. The patient was not febrile and had no leukocytosis. A CT study showed an enlarged distal appendix with a 1.8 x 3.8 cm fluid-like or cystic lesion with mild mural thickening (Figure 1). There was also mild wall thickening of the more proximal appen-dix. There were no enlarged periappendiceal lymph nodes. The patient had a normal appendix on a CT exam ob-tained approximately one and a half year before (Figure 2). A diagnosis of acute appendicitis was made. The patient had a history of previous small bowel resec-tion and exploratory laprotomy, nine and twenty-two years ago, respectively. The reason for these surgeries was small bowel obstruction, otherwise unknown. Due to prior sur-geries and adhesions on laproscopy, open appendectomy was performed. The distal appendix was found to be di-lated with tan-pink and markedly eroded mucosa with a wall thickness of 0.3 cm. The remainder of the resecte