1
|
Oyeh E, Nsaful J, Bediako-Bowan A, Gbadamosi H, Mensah YB, Adu-Aryee NA, Nyarko V. Mucocoele of the appendix. Ghana Med J 2024; 58:109-114. [PMID: 38957279 PMCID: PMC11215239 DOI: 10.4314/gmj.v58i1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Introduction Mucocoele of the appendix occurs in 0.2-0.7% of people in the world without any well-defined clinical symptoms. It occurs when there is an accumulation of mucous in the lumen of the appendix. Case Presentation We present three cases: a 48-year-old male admitted to the emergency room with a one-day history of right iliac fossa pain. Abdominal examination was suggestive of acute appendicitis. The initial abdominal computerised tomography scan was reported as being unremarkable. At surgery, a firm tumour of the appendix was found, and a limited right hemicolectomy was done. Histopathology confirmed a mucocoele of the appendix with borderline mucinous histology.The second case is a 63-year-old man who presented with a one-year history of abdominal distension and weight loss. Previous abdominal ultrasound was suggestive of liver cirrhosis with significant ascitic fluid. Abdominal magnetic resonance imaging found an appendix mucocoele with infiltration of the omentum and scalloping of the liver surface suggestive of pseudomyxoma peritonei. A percutaneous biopsy of the omental mass confirmed metastatic mucinous adenocarcinoma of the appendix.The third case is a 68-year-old man who, during an annual medical check-up, had an incidental finding of a cystic right iliac fossa mass on ultrasound, confirmed on abdominopelvic computerised tomography scan to be an appendix mucocele. He had laparoscopic appendicectomy. The histopathological diagnosis confirmed a mucinous cystadenoma of the appendix. Conclusion Preoperative diagnosis of appendiceal mucocoele is difficult and commonly discovered intraoperatively. The prognosis is good for the histologically benign type, but it is poor when malignant or peritoneal lesions are present. Funding None declared.
Collapse
Affiliation(s)
| | - Josephine Nsaful
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana
- Department of Surgery, Korle Bu Teaching Hospital
| | - Antoinette Bediako-Bowan
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana
- Department of Surgery, Korle Bu Teaching Hospital
| | - Hafisatu Gbadamosi
- Department of Radiology, Korle Bu Teaching Hospital
- Department of Radiology, University of Ghana Medical School, College of Health Sciences, University of Ghana
| | - Yaw Boateng Mensah
- Department of Radiology, Korle Bu Teaching Hospital
- Department of Radiology, University of Ghana Medical School, College of Health Sciences, University of Ghana
| | - Nii A Adu-Aryee
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana
- Department of Surgery, Korle Bu Teaching Hospital
| | | |
Collapse
|
2
|
Kim YJ, Yun JH, Hong SH, Song G, Lee JE, Son MW, Han SW, Kim SY, Lee MS. Appendiceal mucocele masquerading as an epithelial borderline ovarian tumor: a case report and literature review. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2022; 18:83-88. [PMID: 36945242 PMCID: PMC9942759 DOI: 10.14216/kjco.22011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022]
Abstract
Appendiceal mucocele is a rare mucin-producing neoplasm of appendiceal origin. Due to its location and imaging findings, appendiceal mucocele is easily confused with tumors of the right adnexa. We present a rare case of a patient initially misdiagnosed with an ovarian tumor intraoperatively diagnosed as an appendiceal mucocele and successfully treated. A 66-year-old postmenopausal woman was admitted to the gynecology department for an asymptomatic pelvic mass. Preoperative pelvic imaging showed an 8-cm cystic mass. Exploratory laparoscopy for the suspected epithelial borderline tumor from the right ovary revealed a cystic mass in the right pelvic area and normal uterus, fallopian tubes, and ovaries. Intraoperative consultation with the general surgery department confirmed the appendiceal origin. Laparoscopic appendectomy was performed. Histopathological examination confirmed a low-grade mucinous neoplasm of appendiceal origin. The patient was discharged on a postoperative day 5 without complications. The outpatient follow-up performed 1 month later showed no evidence of disease progression. Despite the use of advanced diagnostic tools, appendiceal mucocele may be confused for ovarian malignancies. Because the clinical features of appendiceal mucocele are nonspecific, clinicians and radiologists know the specific imaging findings. A multidisciplinary approach including general surgery, gynecology, and radiology is required for preoperative diagnosis and treatment.
Collapse
Affiliation(s)
- Young Joo Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jong Hyuk Yun
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sung Hoon Hong
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - GeumJong Song
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jong Eun Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Myong Won Son
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sun Wook Han
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sung Yong Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Moon-Soo Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| |
Collapse
|
3
|
Kudelová E, Grajciar M, Smolar M, Kalman M, Laca L. Laparoscopic Right Hemicolectomy for Appendiceal Mucocele. ACTA MEDICA (HRADEC KRÁLOVÉ) 2021; 64:165-169. [PMID: 34779382 DOI: 10.14712/18059694.2021.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Appendiceal mucocele is a rare disease with an incidence of 0.07-0.63% of all appendectomies and was first described in 1842 by Carl von Rokitansky. It is defined as an abnormal intraluminal accumulation of mucin. The clinical picture of AM can vary from asymptomatic mass in the right lower quadrant to symptoms of acute appendicitis. In some cases, AM can be found accidentally on CT performed due to other reasons or during surgery. Diagnosis consists mainly of imaging methods such as ultrasound, CT, and MRI with the finding of encapsulated cystic mass with calcifications. The main goal of surgical treatment is to remove an intact mucocele and prevent spillage of mucin into the peritoneal cavity. We present a case of large mucocele treated with laparoscopic right hemicolectomy.
Collapse
Affiliation(s)
- Eva Kudelová
- Clinic of Surgery and Transplant Centre, Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, Slovakia
| | - Martin Grajciar
- Clinic of Surgery and Transplant Centre, Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, Slovakia.
| | - Marek Smolar
- Clinic of Surgery and Transplant Centre, Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, Slovakia
| | - Michal Kalman
- Department of Pathological Anatomy, Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, Slovakia
| | - Ludovit Laca
- Clinic of Surgery and Transplant Centre, Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, Slovakia
| |
Collapse
|
4
|
Wang TT, He JJ, Zhou PH, Chen WW, Chen CW, Liu J. Endoscopic diagnosis and treatment of an appendiceal mucocele: A case report. World J Clin Cases 2021; 9:3936-3942. [PMID: 34141750 PMCID: PMC8180202 DOI: 10.12998/wjcc.v9.i16.3936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/26/2020] [Accepted: 03/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Appendiceal mucocele is a rare disease that causes obstructive dilatation of the appendix due to the intraluminal accumulation of mucin. We report a case of endoscopic diagnosis and treatment of an appendiceal mucocele.
CASE SUMMARY A 47-year-old man presented with a protrusion around the orifice of the appendix discovered by colonoscopy incidentally. He was admitted to our hospital for a routine checkup without any symptoms. Abdominal computed tomography showed a cystic mass approximately 3 cm in diameter with fat stranding. The preoperative diagnosis was non-neoplastic appendiceal mucocele, and endoscopic treatment was performed. The endoscopic findings and pathological results supported our preoperative diagnosis. The endoscopic treatment of appendiceal mucocele was feasible and effective, which was confirmed by repeated endoscopy and post-operative computed tomography after 7 mo.
CONCLUSION Endoscopic therapy provides a new method for the treatment of appendiceal mucocele.
Collapse
Affiliation(s)
- Ting-Ting Wang
- Department of Gastroenterology, The First Clinical Medical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Jia-Jun He
- Department of Gastroenterology, The First Clinical Medical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Ping-Hong Zhou
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wei-Wei Chen
- Endoscopy Center, Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
| | - Chao-Wu Chen
- Endoscopy Center, Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
| | - Jun Liu
- Endoscopy Center, Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
| |
Collapse
|
5
|
Knol ME, de Leede EM, van Beurden A. Torsion of a mucocele of the veriform appendix: report of a case. J Surg Case Rep 2020; 2020:rjaa442. [PMID: 33274042 PMCID: PMC7694596 DOI: 10.1093/jscr/rjaa442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/30/2020] [Indexed: 12/05/2022] Open
Abstract
Mucocele of the appendix refers to an appendix that is distended by mucus and transformed in a mucus-filled sac. Appendicular torsion is rare. Primary and secondary forms of appendicular torsion are known. Our patient presented to the emergency department with complaints mimicking acute appendicitis. Imaging with computed tomography and ultrasound showed a cystic lesion most likely originating from the right ovary. The veriform appendix was located close to this lesion and seemed to be distended. During diagnostic laparoscopy, a torsion of the veriform appendix due to a mucocele was found and an appendectomy was performed. Histopathological analysis confirmed the diagnosis. Torsion of the vermiform appendix is most often diagnosed intra-operatively. Pre-operative radiologic imaging is often not useful in the detection of appendicular abnormalities other than acute appendicitis. The treatment consists of detorsion and appendectomy.
Collapse
Affiliation(s)
| | - E M de Leede
- Groene Hart Hospital, Department of Surgery, Gouda, The Netherlands
| | - A van Beurden
- Groene Hart Hospital, Department of Surgery, Gouda, The Netherlands
| |
Collapse
|