A Case of Strangulation Ileus Due to a Low-Grade Appendiceal Mucinous Neoplasm

Appendiceal Mucinous Tumor Presenting as Recurrent Bowel Obstruction

Appendiceal mucinous tumors are rare, with variable malignant potential, and they are usually found incidentally. Clinical symptoms are nonspecific. Rarely, appendiceal mucinous neoplasm causes bowel obstruction and makes diagnosis more difficult. We present a case of an 84-year-old female who came to our emergency department having had abdominal fullness and constipation for 5 days. Ileus, due to an affected adhesion band, was diagnosed initially, and symptoms improved gradually under conservative treatment. However, 3 months later she presented to the emergency department again with abdominal pain and distension; small bowel obstruction due to adhesion was again diagnosed. Recurrent bowel obstruction prompted emergent surgery. Operative findings showed a whitish appendiceal tumor adhering to and directly invading the adjacent ileum, with a segment of herniated small bowel wedged in between, causing the obstruction. Upon reviewing the initial computed tomography scan, the dilated tubular structure of appendiceal tumor was misrecognized as small bowel loop; there was no surrounding inflammatory sign, leading to diagnosis difficulty. Instead of a common cause of bowel obstruction, such as adhesion band, this case revealed bowel obstruction can be caused by the direct invasion of an appendiceal tumor. Awareness of this condition with careful image evaluation of small bowel obstruction is essential for diagnosis.

OUP accepted manuscript

Primary neoplasm of the appendix is often diagnosed incidentally after an appendectomy. Low-grade appendiceal mucinous neoplasms (LAMNs) make up a small portion of these neoplasms. We present a rare case of a patient with a slow-growing LAMN causing urinary retention and constipation. The mass was initially found incidentally 25 years prior, but the patient declined further workup since he was asymptomatic at that time. The patient experienced progressively worsening abdominal discomfort related to urinary retention and difficulty in evacuating his bowels. Imaging identified a large abdominal mass (19.3 × 8.7 × 13.5 cm). The mass was surgically resected. Pathology was consistent with a LAMN. In general, an incidental finding of an abdominal mass should be further investigated regardless of symptomology. Patients should be educated about the potential of malignancy and the need for a major abdominal surgery in the future if they choose not to have a mass further evaluated.