The Abscess That Wasn’t

I first met Madam Ooi in May 2012.

She complained of persistent pain in the lower right side of her abdomen.

“It’s an abscess….” she was told by her doctor. An abscess is a collection of pus. Indeed, she had an operation for this 5 months ago.

She was found at laparoscopy to have pus around the right side of her abdomen next to the colon (large bowel). The pus was removed at the time.

But her pain hadn’t settled.

Abscesses occur in this location commonly due to perforated appendicitis. Another common cause would be infections around the right ovary and fallopian tube.

A repeat CT scan of her abdomen was reported to show an abscess and a calcified appendix. However, she told me she had had her appendix removed over 10 years ago!

CT scan of Madam Ooi
CT scan of Madam Ooi

Something wasn’t right.

It was time to do a colonoscopy examination of her large bowel. I found an ulcer in the caecum, that is, the first part of the large bowel just where the small bowel joins it.

Colonoscopy photo showing ulcer and mass
Colonoscopy photo showing ulcer and mass

Biopsy of the ulcer showed only inflammatory tissue, negative for cancer. But my gut feeling told me otherwise. So I advised her to have that section of the large bowel removed, then joined up again (Laparoscopic right hemicolectomy).

At operation, there was indeed a small pocket of pus next to the colon. However, there was also a bulky mass there and everything was very stuck down. We removed the mass and joined the bowel up again. All done with laparoscopic keyhole surgery via an incision only 5cm long.

Madam Ooi's tummy. Note the old appendix scar in the lower abdomen.
Madam Ooi’s tummy. Note the old appendix scar in the lower abdomen.

The report from the lab confirmed my suspicion – bowel cancer which had perforated and caused an abscess nearby.
Good thing we had operated and removed the mass, even though the biopsy and the CT scan hadn’t shown cancer!

She made a splendid recovery from her operation, then completed a course of chemotherapy here.

She is now 3 years after surgery and remains well with no pain and no evidence of recurrent cancer.

Dr Khoo with Madam Ooi, May 2015
Dr Khoo with Madam Ooi, May 2015