Appendicitis and occult carcinoma of the caecum.

Appendicitis can occur rarely in association with carcinoma of the caecum, particularly in the elderly. If this possibility is not appreciated and thorough laparotomy is not carried out at the time of initial surgery, an early malignant lesion may go unrecognised. In this situation, if appendicectomy is performed, it will need to be revised to a right hemicolectomy at a later date. Survival chances are then affected adversely due to the possibility of early dissemination of malignant disease through the breaching of intestinal integrity and tumour cell spillage. Two cases are reported where carcinomatous recurrence occurred in the appendicectomy wound, probably as a result of initial appendicectomy at which the co-existent caecal neoplasm was missed.