Intussusception of a mucocele of the appendix

Abstract

rare. W e r e p o r t w h a t we believe to be the 2 8 t h r e c o r d e d case, a n d d i s c u s s the clinical feat u r e s a n d p r e o p e r a t i v e d i a g n o s i s o f this c o n d i t i o n .causing its deformity (Fig. 1). A hypotonic duodenogram carried out five days later when the patient was asymptomatic showed a normal duodenum.During the asymptomatic pcriod following his admission, a double contrast enema was also carried out and this confirmed the suspicion from the upper gastrointestinal series, that he was having intermittent intussusception and demonstrated an extrinsic mass at the lower caecal pole (Fig. 2). The appendix and terminal ileum were not demonstrated, but the features on this examination were suggestive of a benign "tumour', probably of the appendix and this was considered to be the cause of the intussusception.Elective laparotomy was carried out four weeks after presentation. The only abnormality found was that the appendix was grossly dilated and its proximal one third was intussuscepted into the caecum (Fig. 3). Thc peritoneum of the appendix and terminal 7.5 cm of ileum was thickened with fibrous adhesions to thc greater Case ReportA 21-year-old male Caucasian studcnt was admitted as all emergency with a five week history of increasing colicky peri-umbiIical pain without gastrointestinal upset. He was apyrexial on admission, had moderate epigastric tenderness but no rebound tenderness. No abdominal masses were palpable and he had normal bowel sounds. Rectal examination was normal and faecal occult blood was negative. On admission he had a normal white blood count, normal erythrocyte sedimentation rate (ESR), and normal liver function tests. The serum amylase was 500 (normal range 50-300 units/litre). Admission supine plain radiograph of the abdomen showed that the gas-filled bowel was mainly on the left side of the abdomen. There was no evidence of a soft tissue mass, calcification, localised ileus, or obstruction.Diagnosis of mid-gut colic was made and he was treated empirically with propantheline bromide with complete resolution of symptoms within 24 h. Barium meal and small bowel series demonstrated initially a space occupying mass lesion within the duodenal loop, stretching the distal 2nd, 3rd, and 4th parts, and displacing the gastric antrum. However, later in the small bowel series, the intussusceptum was demonstrated lying in the transverse colon, outlined by contrast, and overlying the 'C'-loop of the duodenum, Address roprint requests to." Dr. N.J. Douglas, University of Edinburgh, Department of Medicine, The Royal Infirmary, Edinburgh EH3 9YW, UK. Fig. 1. A small bowel series showing the intussusceptum outlined by contrast. The intussusception has reached the proximal transverse colon, overlying the duodcnal loop, and causing local displacements 0364-2356/78/0003-0097 $01.00 9 1978 S p r i n g e r -V e r l a g N e w Y o r k Inc.

Intussusception of the Appendix Secondary to Mucinous Cystadenoma

“…Tsunoda et al [4]reported about 24 cases of intussusception of the appendix in combination with a mucocele in Japan, 11 males and 13 females, with the mean age of 55.2 ± 3.5 (range 21–86) years. Douglas et al [2]reported about 27 cases with this condition in Western countries, with the mean age of 48 years and female predominance. Thus the mean age of patients suffering from this entity is much higher and amounts to 53 years.…”

“…This filling defect has to be differentiated from other causes by colonoscopy, such as polyps or malignancies [2]. The use of US and CT increased the number of the preoperatively diagnosed cases of intussusception of the appendix.…”

“…The combination of a mucinous cystadenoma with an intussuscepted appendix is extremely rare [1, 2, 3, 4]. …”