Sessile Serrated Adenoma of the Appendix and Perforated Cecal Lymphoma in a Nonagenarian on Novel Anticoagulant Undergoing Emergent Surgery: The Challenges, Decision Making and Management of a Rare Case
Bibliographic record
Abstract
A 92-year-old male with significant past medical history of atrial fibrillation, congenital heart disease, coronary artery disease (CAD), deep vein thrombosis (DVT), hyperlipidemia (HLD), hypertension (HTN), myocardial infarction (MI), and peripheral vascular disease presented to emergency department (ED) with shortness of breath and right sided chest pain. He was hypotensive and tachycardic with right upper and lower quadrant tenderness on clinical examination. Initial pulmonary embolism (PE) protocol CT scan was negative for pulmonary embolism but revealed a large 13 cm mass in right lower quadrant (RLQ) with adjacent free peritoneal air and fluid, suspicious for perforated cecal neoplasm or abscess. He received activated prothrombin complex concentrate (PCC) for emergent reversal of apixaban and taken emergently for exploratory laparotomy, where he underwent an extended right hemicolectomy with end ileostomy and a long Hartmann’s. The ileocecal lesion was large and extended from the terminal ileum to almost the hepatic flexure. Histopathology revealed high-grade B-cell lymphoma involving the terminal ileum, cecum, ascending colon, appendix, and mesenteric lymph nodes. The specimen also contained a serrated sessile appendicular adenoma. We discuss urgent/emergent surgeries in nonagenarians with multiple comorbidities on novel oral anticoagulant (NOAC) as well as the indications of palliative surgery in these patient groups. We also discuss synchronous serrated adenoma along with the perforated high-grade lymphoma in the same patient. J Med Cases. 2018;9(9):313-319 doi: https://doi.org/10.14740/jmc3124w
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".