Patient: The patient was a 57-year-old female Yugoslav-born Venezuelan, with almost her entire life living in Venezuela. She was admitted to hospital because of acute abdominal pain. Symptoms began four months before admission with pain at the lower chest, evaluated by a cardiologist, who did not find evidences of cardiac lesions. Three months before admission, she had pain at the lower abdominal quadrants with irradiation to lumbar regions, receiving symptomatic treatment, without amelioration of symptoms. The day of admission she had an acute pain at the hypogastrium and lower right quadrant (LRQ), weight loss of 10 kg in four months, with no fever. The physical examination showed a painful mass at the LRQ with characteristics of an acute abdomen. The diagnostic presumptions were: a) malignancy of the colon because of her age and 2) acute appendicitis.