Ultrasound catheter probe detection of appendiceal mucocele

Evaluation of subepithelial abnormalities of the appendix by endoscopic ultrasound

Background. The use of through-the-scope (TTS) miniprobe catheter endoscopic ultrasound is a valuable technique for evaluating subepithelial lesions in the proximal colon. Few reports include the evaluation of the appendix by EUS. Objective. To describe endoscopic and endosonographic characteristics of subepithelial lesions of the appendix. Methods. Retrospective case series in a single academic medical center. Adult patients referred for evaluation of subepithelial lesions of the appendix identified by colonoscopy between April 1, 2003 to February 29, 2008. Data were abstracted from an electronic endoscopic database for all patients undergoing miniprobe endoscopic ultrasound examination of the appendix. Medical records were reviewed for patient followup and outcomes. Results. Nine cases were identified. Seven (78%) patients were female. Seven (78%) utilized the 12 MHz miniprobe device and two (22%) used the 20 MHz device. Three mucoceles were described and confirmed by surgical resection. Cases also included one inverted appendix, one gastrointestinal stromal tumor, and one lipoma. In three cases, no abnormality was found. Conclusions. EUS evaluation of the appendix is feasible with standard miniprobe devices and may assist in the selection of patients who may benefit from surgical management.

Appendiceal intussusception diagnosed with endoscopic sonography

Intussusception of the appendix vermiformis is an uncommon cause of abdominal pain. Several imaging modalities are of limited value in diagnosing this rare condition, including barium enema, transabdominal sonography, and CT. We report a case of intussusception of the appendix vermiformis with the clinical presentation of intermittent abdominal pain in the right lower quadrant. Colonoscopy revealed an erythematous polypoid lesion at the cecal base. Endoscopic sonography demonstrated a multiconcentric structure and enabled the tentative diagnosis of intussusception of the appendix vermiformis. Laparoscopic surgery with a reduction of the appendix and appendectomy was performed and confirmed the diagnosis.

Colonoscopic diagnosis of mucocele of the appendix

BACKGROUND

Appendiceal mucoceles are uncommon cystic neoplasms characterized by distension of the appendiceal lumen with mucus. There have been no reported series of colonoscopically diagnosed mucoceles with clinicopathologic correlation.

METHODS

A retrospective review of colonoscopies performed at our institution over the past 14 years was undertaken with patient demographics, clinical data, surgical outcomes, and histopathology obtained from hospital records.

OBSERVATIONS

Seven patients (6 women) with mucocele of the appendix were identified at colonoscopy. Three had complained of right lower quadrant pain. All 7 patients underwent surgical resection. Histopathology demonstrated mucinous cystadenoma in all. No cases revealed carcinoma, and there have been no deaths related to the mucocele.

CONCLUSIONS

Appendiceal mucoceles may be recognized at colonoscopy as a smooth bulbous submucosal lesion of the cecum with an impression formed by the appendiceal orifice. Recognition at colonoscopy is important because it enables accurate diagnosis and directs management. Surgery is recommended in all cases given the risk of malignancy or perforation with resultant pseudomyxoma peritonei.