Abstract Mucinous adenocarcinoma of the appendix is a rare neoplasm with a low propensity for lymph node metastasis. The present case refers to an appendicular mucinous adenocarcinoma with inguinal lymph node metastasis. A 71-year-old woman underwent an appendectomy due to a clinical presentation of acute appendicitis. However, the histological examination of the surgical specimen revealed a mucinous adenocarcinoma of the appendix. After staging, the patient underwent a right hemicolectomy and was proposed for adjuvant chemotherapy. At the 3rd year of follow-up, inguinal lymphadenopathy was diagnosed, which biopsy confirmed inguinal node metastases from primary colorectal cancer, with areas of extracellular mucin. Restaging revealed liver and peritoneal metastasis, and the patient was proposed for palliative chemotherapy. Appendicular neoplasms, due to their rarity, represent a diagnostic and therapeutic challenge. This clinical case depicts an unusual metastasis pathway for an unusual neoplasm.

Introdução: A pancreatite aguda é responsável por um número significativo de internamentos hospitalares. A maioria dos doentes é admitido pelo Serviço de Urgência. A identificação precoce do fator etiológico é essencial, quer pelas suas implicações na terapêutica imediata, quer na prevenção das recorrências. Apesar de frequentemente linear, a investigação etiológica pode constituir um desafio considerável. Conclusão: Vários são os estudos que enfatizam as múltiplas etiologias, no entanto são raras orientações diagnósticas estruturadas que permitam encetar um estudo racional e orientado por critérios bem estabelecidos. O objetivo deste trabalho é a elaboração de um protocolo de atuação, que pretende servir como um guia para a investigação etiológica das pancreatites agudas, baseado numa revisão dos trabalhos publicados, adaptada à realidade deste Hospital e meios disponíveis.

Background: Acute pancreatitis represents a significant number of hospital admissions. Most of the patients are admitted in an acute setting. Early identification of its etiology is an essential step toward the rational approach, both for its implications in the immediate therapy and the prevention of recurrence. Although often obvious, the etiological workup of acute pancreatitis can be challenging. Conclusion: There are several studies emphasizing the multiple etiologies underlying acute pancreatitis but lacking structured diagnostic workups to allow a rational and organized study. The main goal of this work is to develop an algorithm proposal, which aims to serve as a guide for the investigation of the etiology of acute pancreatitis based on a review of already published literature, adjusted to the reality of our hospital and the available resources.