A case report of a giant appendiceal mucocele and literature review

Abstract

A 43-year-old female presented at the accident and emergency department of Princess Marina Hospital, Gaborone, Botswana. She reported a deep dull aching pain of two years duration in the right iliac fossa that has been progressively becoming worse. Ultrasound revealed a large sausage like cystic mass extending from the pelvis up to the medial aspect of the ascending colon. CT scan showed a large sausage like cystic mass extending from the pelvis up to the hepatic flexure of the colon with the cecum displaced. No metastatic features were seen. We made an impression of appendiceal mucocele. A semi-elective laparotomy was scheduled. Intraoperative findings: a giant intact cystic distended appendix with involved base, displacing the cecum cranially. A right hemicolectomy was performed. The histopathological results revealed a low-grade appendicular mucinous neoplasm with no lymph node involvement. The surgical margins were free. The patient recovered uneventfully.

Impending Rupture With a Twisted Huge Appendiceal Mucocele Treated With Totally Laparoscopic Resection: A Case Series

“…However, some studies assume that secondary torsion of the appendix, like our presented cases, could be similar to ovarian torsion, which twists around its own axis, with a fulcrum of the short segment of the normal appendix between the cystic mass and cecum [9,10]. Histologically, appendiceal mucocele can be categorized into 4 causes: retention cyst, mucosal hyperplasia, LAMN or mucinous cystadenoma, and mucinous cystadenocarcinoma [4][5][6]9]. More than half of mucinous tumors (52% to 58%) are considered malignant tumors of the appendix [5,6].…”

“…Spontaneous or iatrogenic rupture of appendiceal mucocele may lead to dissemination of epithelial cells that produce mucins into the peritoneal cavity. This may cause PMP, which may affect the long-term prognosis of the disease, especially with malignant mucocele [4][5][6][7]. Moreover, this may lead to life-long complicated management, including debulking, peritonectomy, and heated intraperitoneal chemotherapy (HIPEC) [4,6].…”

“…This may cause PMP, which may affect the long-term prognosis of the disease, especially with malignant mucocele [4][5][6][7]. Moreover, this may lead to life-long complicated management, including debulking, peritonectomy, and heated intraperitoneal chemotherapy (HIPEC) [4,6]. Even with these great efforts, according to previous studies, the 5-year survival rate of PMP is only 25% [6].…”

Endoscopic diagnosis and treatment of an appendiceal mucocele: A case report

“…And there was no recurrence at the 6-mo follow-up after a simple appendectomy. Motsumi et al [ 4 ] presented a case of giant appendiceal mucocele that was treated by a right hemicolectomy, and the patient recovered uneventfully. Simple appendectomy is the optimal treatment for patients with a histological diagnosis of benign mucocele.…”

“…The preoperative diagnosis of appendiceal mucocele is very difficult. Up to 50% of cases are asymptomatic and discovered incidentally during radiology, endoscopy, or surgery[ 4 ]. The most frequent symptom is nonspecific abdominal pain, usually accompanied by a palpable mass in the right iliac fossa, nausea, vomiting, and weight loss[ 5 ].…”