Introduction: This case presentation follows a pediatric patient who was initially worked up for constipation, then appendicitis, eventually ruled as an appendiceal neoplasm.

Case Presentation: 11 year old male presents to the ED with waxing and waning abdominal pain for past month that was exacerbated in the past 24 hours. Patient has associated nausea, vomiting, fever, and decreased appetite. Physical exam showed palpable stool in ascending and descending colon, general mild tenderness to palpation, no rebound tenderness, no guarding. Differential diagnosis included abdominal pain and constipation, patient was recommended Miralax with primary care follow up in 1 week. Patient discharged, presents again within 9 hours to the ED with persistent abdominal pain despite taking enema and Miralax, associated diarrhea, and nausea. Physical exam showed soft, nondistended mild generalized tenderness in RLQ, no guarding, no rebound tenderness, no CVA tenderness. CT scan may represent engorged, fluid filled appendix. Differential diagnosis included acute appendicitis, and patient was admitted to pediatric floor with immediate surgical intervention needed for appendectomy. The operation began as a laparoscopic procedure, but due to tough scar tissue surrounding the appendix, surgery was converted to open. Preliminary report states concern for a carcinoma with low probability of lymphoma.

Final/Working Diagnosis: Low-grade mucinous appendiceal neoplasm.

Management/Outcome: Resection of neoplasm, pathological evaluation, median follow up of 6 years.

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