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

Abstract

Torsion of the appendix is rare, and appendiceal mucocele can be one of its causes. The first case was of a 49-year-old man who visited the emergency room (ER) for abdominal pain. Abdominal computed tomography (CT) showed appendiceal mucocele with suspected torsion and rupture. The patient underwent laparoscopic exploration and appendectomy. The second case was of a 69-year-old man who visited the ER for epigastric pain. Abdominal CT showed suspicious appendiceal mucocele with ischemic change, indicating torsion of the appendix. The twisted appendix was successfully removed by laparoscopic exploration. An appendiceal mucocele is one of the causes of twisted appendix. With torsion, the mucocele can be diagnosed as rupture by ischemia which may lead to pseudomyxoma peritonei. For this reason, open laparotomy has traditionally been preferred. However, an unruptured appendiceal mucocele or impending rupture with torsion of the appendiceal mucocele can be treated with totally laparoscopic surgery.

Benign multicystic mesothelioma of appendiceal origin treated by hyperthermic intraperitoneal chemotherapy: A case report

“…The pathophysiology of this disease is uncertain. However, several hypotheses have been proposed, such as conditions related to inflammatory response to previous abdominal surgery, endometriosis, pelvic inflammatory disease and other similar causes [3] . Apart from symptoms, physical examination is also non-specific, and therefore PBCM is usually diagnosed by chance.…”

Uncommon cause of acute appendiceal torsion mucocele

“…Appendicular torsion is most often diagnosed intraoperatively; some preoperative radiologic imaging findings could suggest torsion’s presence, particularly secondary torsion 2–6. A missed torsion diagnosis preoperatively is usually not catastrophic because the differentials often include acute appendicitis or ovarian torsion, of which, for exclusion, they require a diagnostic laparoscopy 2–6. Possible causes of appendicular torsion and a brief description of presentation patterns are summarised in table 1.…”

“…In all cases, minimal handling of the appendix proper is highly recommended 2–6. This is important so as not to rupture the appendicular mucocele accidentally.…”

“…This is important so as not to rupture the appendicular mucocele accidentally. Inadvertent rupture has severe clinical implications from the spillage of mucinous content, which can lead to pseudomyxoma peritonei,4 5 which has a poor 10-year survival rate of 10%–30% 4. Following appendicectomy, if the histopathology shows mucinous cystadenocarcinoma or a high degree of suspicion at the index case of the lesion spreading to the ascending colon, an oncological lymphadenectomy right hemicolectomy is required 4 5…”

“…Meanwhile, secondary torsion of the appendix involves a primary lesion such as a faecolith, lipoma or appendicular mucocele. Appendiceal mucocele is further subclassified into non-neoplastic variants (mucosal hyperplasia and mucosal retention cyst) and neoplastic variants (mucosal adenoma, low-grade mucinous neoplasm and mucinous cystadenocarcinoma) 2–6…”