A Patient with an Acute Abdomen who had Torsion of an Appendiceal Mucocele

Abstract

A 42-year-old man with a chief complaint of epigastric discomfort, nausea, and lower abdominal pain was initially seen by a local physician and then referred to our hospital for further evaluation. Laboratory tests showed an elevated inflammatory response, and abdominal CT showed a 60-mm cystic lesion contiguous with the appendix. The patient was diagnosed with acute appendicitis and an appendiceal tumor. Conservative treatment with nothing by mouth (NPO) and antibiotics was started. However, the abdominal symptoms suddenly worsened on the day after hospital admission, so urgent surgery was performed. Laparotomy was performed with a midline incision of the lower abdomen, and the intraoperative findings showed torsion of an appendiceal mucocele. The torsion was reduced, followed by appendectomy. Histopathology showed an appendiceal mucocele. The patient had a satisfactory postoperative course and was discharged on day 8 after surgery. Torsion of an appendiceal mucocele is a rare condition, with only 15 previous case reports in Japan. This case of torsion of an appendiceal mucocele in a Japanese patient with an acute abdomen is reported along with a discussion of the relevant literature.