1
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Zabeirou A, Efared B, James Didier L, Younssa H, Adama S, Moussa Y, Rachid S. Appendiceal mucocele as an exceptional cause of ileocecocolic intussusception in adults: a case report. J Med Case Rep 2023; 17:392. [PMID: 37710264 PMCID: PMC10503163 DOI: 10.1186/s13256-023-04133-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Intussusception is a rare condition in adults, accounting for 5% of intestinal intussusception and being responsible for approximately 1% of all adult bowel obstructions. Neoplastic origin is the most common etiology of intestinal intussusception in adults, unlike pediatric intussusception, which is usually idiopathic. Intussusception due to the appendiceal mucocele is exceptional, and only a few cases have been reported in the medical literature. CASE PRESENTATION We report the case of a 25-year-old black African male patient with no medical history. He presented to the emergency department for abdominal pain, nausea, and bilious vomiting. The abdominal examination revealed typical signs of acute bowel obstruction. Enhanced abdominopelvic computed tomography showed an invagination of the last ileal loop, cecum, and ascending colon into the lumen of the transverse colon, with a rounded image with hypodense content and some calcifications compatible with an appendiceal mucocele. An emergency exploratory laparoscopy was performed and confirmed the ileocecocolic intussusception. Right hemicolectomy and ileocolic anastomosis were performed. The patient recovery postoperatively was uneventful, and he was discharged 4 days later. Histological examination of the surgical specimen confirmed the diagnosis of mucinous cystadenoma. CONCLUSION The symptoms of bowel intussusception with the appendiceal mucocele as the lead point in adults are similar to any other bowel intussusception. Differential diagnosis is often carried out thanks to the injected abdominal computed tomography scan.
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Affiliation(s)
- Aliou Zabeirou
- Department of General and Visceral Surgery, Hôpital Général de Référence, Niamey, Niger.
| | - Boubacar Efared
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Lassey James Didier
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Hama Younssa
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Saidou Adama
- Department of General and Visceral Surgery, Hôpital Général de Référence, Niamey, Niger
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Younoussa Moussa
- Department of General and Visceral Surgery, Hôpital Général de Référence, Niamey, Niger
| | - Sani Rachid
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
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2
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Derbal S, Klapczynski C, Charissoux A, Durand Fontanier S, Taibi A. Management of mucocele of the appendix with peritoneal dissemination in pregnant women: a case report and literature review. Acta Chir Belg 2023; 123:185-191. [PMID: 34266364 DOI: 10.1080/00015458.2021.1956800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND This is the first case report of a patient with a twin pregnancy who developed appendiceal mucocele (AM) with peritoneal dissemination in the context of endometriosis and ovarian hyperstimulation. A review of the literature on AM during pregnancy, with a focus on management, is provided as well. CASE PRESENTATION A 36-year-old woman was admitted to the emergency department for abdominal pain in the right iliac fossa at 17 weeks of amenorrhoea (WA). She was pregnant with twins, achieved by in vitro fertilisation (IVF) and complicated by ovarian hyperstimulation syndrome. Abdominal ultrasonography indicated a diagnosis of uncomplicated acute appendicitis. However, the histopathological findings revealed low-grade appendicular mucinous neoplasia (LAMN) with peritoneal dissemination of acellular mucin. Maximal cytoreductive surgery with hyperthermic intraperitoneal mitomycin chemotherapy was performed post-partum. CONCLUSIONS Specialised management is required for AM during pregnancy and must take into account the progress of the pregnancy, the histology of the AM and the risk of perforation.
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Affiliation(s)
- Sophiane Derbal
- Digestive and Endocrine Surgery Department, Limoges University Hospital, Limoges, France
| | | | | | - Sylvaine Durand Fontanier
- Digestive and Endocrine Surgery Department, Limoges University Hospital, Limoges, France.,CNRS, University of Limoges, XLIM, UMR 7252, Limoges, France
| | - Abdelkader Taibi
- Digestive and Endocrine Surgery Department, Limoges University Hospital, Limoges, France.,CNRS, University of Limoges, XLIM, UMR 7252, Limoges, France
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3
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Bejiga G. Appendiceal mucocele presenting as a leading point in ileocolic intussusceptions: "Case report". Int J Surg Case Rep 2022; 96:107307. [PMID: 35759987 PMCID: PMC9240364 DOI: 10.1016/j.ijscr.2022.107307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Appendiceal mucocele is a rare clinical scenario, which is found in 0.2-0.7 % of appendectomies. Ileocecal/ileocolic intusception caused by appendiceal mucocele is an extremely rare condition with few case reports in literatures. The treatment is surgery with the extent determined by intra-operative findings. Ultrasound and CECT scan can suggest the diagnosis, but definitive diagnosis is by histopathology. The aim of this presentation is to discuss appendiceal mucocele in terms of clinical features, diagnostic imaging and treatment. This case report can create awareness to primary care physicians, radiologists, surgeons and pathologists aiding in accurate diagnosis and early surgical intervention to prevent rupture. PRESENTATION OF THE CASE A fifty years old woman presented with intermittent colicky peri umbilical abdominal pain of one-week duration. She had nausea, vomiting, mild abdominal distension, and failure to pass feces and flatus. Physical examination was normal. Imaging suggested ileocolic intussusceptions with cystic leading point on ultrasound, but on CECT scan, no leading point reported. Appendiceal mucocele diagnosed intra operatively and confirmed by pathology. CONCLUSION Appendiceal mucocele is rare and can be benign or malignant. Preoperative diagnosis is often difficult. Definitive diagnosis is by histopathology. Appendiceal mucocele can rarely present with ileocolic intussusceptions. Radiologists, pathologists, primary care physicians and surgeons must be aware of this condition. Accurate preoperative diagnosis and early surgical treatment of appendiceal mucocele is important to prevent complications like pseudo myxoma peritonei(PMP), which has poor prognosis.
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Affiliation(s)
- Gosa Bejiga
- Adama Hospital Medical College, Adama, P.O. Box:84, Ethiopia.
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4
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Ponzini F, Kowal L, Ghafoor M, Goldberg A, Chan J, Lamm R, Cannaday SM, Richard SD, Nevler A, Lavu H, Bowne WB, Rosenblum NG. Rare occurrence of pseudomyxoma peritonei (PMP) syndrome arising from a malignant transformed ovarian primary mature cystic teratoma treated by cytoreductive surgery and HIPEC: a case report. World J Surg Oncol 2022; 20:78. [PMID: 35272690 PMCID: PMC8915470 DOI: 10.1186/s12957-022-02548-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pseudomyxoma peritonei (PMP) syndrome is a disease process that typically occurs from ruptured appendiceal mucocele neoplasms. PMP syndrome arising from malignant transformation of an ovarian primary mature cystic teratoma (MCT) is a pathogenesis rarely encountered. Case Presentation Herein, we report a 28-year-old patient evaluated and treated for a right ovarian mass and large volume symptomatic abdominopelvic mucinous ascites. Molecular profiling and genetic analysis revealed mutations in ATM, GNAS, and KRAS proteins while IHC demonstrated gastrointestinal-specific staining for CK20, CDX2, CK7, and SATB2. Peritoneal cytology showed paucicellular mucin. Diffuse peritoneal adenomucinosis (DPAM) variant of PMP arising from a ruptured ovarian primary MCT after malignant transformation to a low-grade appendiceal-like mucinous neoplasm was ultimately confirmed. Treatment included staged therapeutic tumor debulking and right salpingo-oophorectomy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Conclusions Our report builds upon the existing literature supporting this aggressive treatment option reserved for advanced abdominal malignancies utilized in this patient with a rare clinical entity.
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Affiliation(s)
- Francesca Ponzini
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Luke Kowal
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mariam Ghafoor
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Allison Goldberg
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Joanna Chan
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ryan Lamm
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Shawnna M Cannaday
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Scott D Richard
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Avinoam Nevler
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Harish Lavu
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Wilbur B Bowne
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Norman G Rosenblum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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5
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Ahn HM, Lee SH. Impending Rupture With a Twisted Huge Appendiceal Mucocele Treated With Totally Laparoscopic Resection: A Case Series. Ann Coloproctol 2021; 37:S34-S38. [PMID: 34182716 PMCID: PMC8359704 DOI: 10.3393/ac.2020.00150.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/14/2020] [Indexed: 11/11/2022] Open
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.
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Affiliation(s)
- Hong-Min Ahn
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Si-Hak Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
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6
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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7
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Lu A, Cho J, Vazmitzel M, Layfield L, Staveley-O'Carroll K, Gaballah A, Rao D. High-grade appendiceal mucinous neoplasm presenting as a giant appendiceal mucocele. Radiol Case Rep 2021; 16:1051-1056. [PMID: 33680275 PMCID: PMC7917446 DOI: 10.1016/j.radcr.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 01/03/2023] Open
Abstract
Appendiceal mucinous neoplasms are rare findings defined by an accumulation of mucus within the vermiform appendix, and can be caused by a variety of conditions. Appendiceal mucinous neoplasms are important to consider because they can develop into pseudomyxoma peritonei as a consequence of perforation. We report a case of a 55-year-old man who initially presented with increasing abdominal girth, constipation, anorexia, and unintentional weight loss. Computed tomography examination of the abdomen and pelvis demonstrated a huge thin-walled cystic mass causing significant displacement of the surrounding abdominal and pelvic structures. The mass was amenable to resection and removed without perforation. Gross pathologic examination demonstrated a 44.0 × 40.0 × 23.0 cm unilocular cystic mass with a section of attached bowel. Microscopic examination revealed high-grade appendiceal mucinous neoplasm arising in a background of low-grade appendiceal mucinous neoplasm. This case report provides an evidence to include appendiceal mucinous neoplasms in the differential diagnosis of large abdominal cystic masses.
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Affiliation(s)
- Alan Lu
- University of Missouri – Columbia School of Medicine, Columbia, MO
| | - Junsang Cho
- University of Missouri – Columbia School of Medicine, Columbia, MO
| | - Maryna Vazmitzel
- Department of Pathology, University of Missouri Health Care, Columbia, MO, USA 65212
| | - Lester Layfield
- Department of Pathology, University of Missouri Health Care, Columbia, MO, USA 65212
| | | | - Ayman Gaballah
- Department of Radiology, University of Missouri Health Care, Columbia, MO
| | - Deepthi Rao
- Department of Pathology, University of Missouri Health Care, Columbia, MO, USA 65212,Corresponding author.
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8
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Abstract
Mucocele of the appendix is a very rare disease entity that often discovered incidentally during surgery. It can result from both non-neoplastic and neoplastic lesions and histopathological examination is needed for confirmation. Failure to make an early preoperative diagnosis may results in its rapture and spillage of mucin contents into the peritoneal cavity leading to a disastrous complication of pseudomyxoma peritonei (PMP) that has a very bad prognosis. A clear pathological terminology and management strategies of appendiceal mucocele (AM) is lacking. This literature review aims to derive detailed information related to clinical significance of AM to avoid complication of PMP and plan appropriately during surgery according to the current evidence. The relevant articles from scientific databases such as Medline, PubMed, Google Scholar were searched and extracted using the keywords “mucocele appendix” “cystadenoma%”. Data based on epidemiology, clinical manifestations, complications, pathology, diagnostic work up and management were analyzed and summarized. A meticulous surgical excision is the mainstay of treatment and open surgical approach is still preferred over laparoscopy. Preoperative diagnosis of AM is very imperative as it may harbour neoplasm and can be made utilising the imaging tools like computed tomography and ultrasonography. Primary care physicians can have a crucial role in making early detection and timely referral for appropriate management in order to avoid complications. After appendectomy, 5-year survival rate for the simple AM is 91%-100% but it reduces to 25% for the malignant AM.
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9
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Soon JQJ, Aftab S, Ling LLA, Uppaluri SAS, Kok SXS. Appendicitis mimicking the CT appearance of an appendiceal mucinous neoplasm. J Radiol Case Rep 2020; 14:26-38. [PMID: 33708342 DOI: 10.3941/jrcr.v14i11.4081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Occasionally, radiologically diagnosed acute appendicitis is found to harbour underlying appendiceal neoplasm on post-surgical histopathology. Conversely, a situation in which radiologically, the appendix demonstrates features consistent with an underlying tumour but post-operative pathology finds no evidence of neoplastic change is rare. We describe a case of a 50-year-old man who presented with a markedly dilated "mass-like" appendix with minimal inflammatory changes on a computed tomography scan. Radiological findings were suspicious for an appendiceal neoplasm/mucocele (i.e. low-grade mucinous neoplasm). However, the post-surgical histopathological diagnosis did not concur with the radiological diagnosis and instead demonstrated findings compatible with acute appendicitis without neoplastic change. In this case report we provide a histopathological correlation and an explanation as to how this may have happened with the hope of helping radiologists avoid this pitfall in the future.
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Affiliation(s)
- Jia Qi Jeremy Soon
- Department of Diagnostic Radiology, Sengkang General Hospital Singapore, Singapore
| | - Syed Aftab
- Department of Diagnostic Radiology, Sengkang General Hospital Singapore, Singapore
| | | | | | - Shi Xian Shawn Kok
- Department of Diagnostic Radiology, Sengkang General Hospital Singapore, Singapore
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10
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Yanagawa S, Yoshinaka H, Tanji H, Kodama S, Takeshima Y, Sumimoto K. Rare Cases of Low-Grade Appendiceal Mucinous Neoplasm: Two Case Reports and a Literature Review. Case Rep Oncol 2019; 12:488-493. [PMID: 31320872 PMCID: PMC6616053 DOI: 10.1159/000501307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Abstract
Appendiceal mucocele (AM) is rare disease found in <1% of all appendectomy specimens. AM is often misdiagnosed as appendicitis because the most frequent symptom is right lower quadrant abdominal pain. AM should be considered in the differential diagnosis of abdominal pain. Although there are pathological classifications, surgical resection is accepted as the treatment to prevent the development of peritoneal pseudomyxoma (PP); however, the optimal surgical technique that must be used is unclear. We present two cases suspected of being AM prior to surgery that were pathologically diagnosed as low-grade appendiceal mucinous neoplasms. Each case progressed without developing PP. The surgical procedures we chose are considered appropriate for each case.
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Affiliation(s)
| | - Hisaaki Yoshinaka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hidehiro Tanji
- Department of Surgery, Yoshida General Hospital, Akitakata City, Japan
| | - Shinya Kodama
- Department of Surgery, Yoshida General Hospital, Akitakata City, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Sumimoto
- Department of Surgery, Yoshida General Hospital, Akitakata City, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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11
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Sharma P, Soin P, Chugh M, Goyal P. Dilated Appendix: Is There More to It? Case Report and Brief Review of Literature with Radiologic-Pathological Correlation. J Clin Imaging Sci 2019; 9:9. [PMID: 31448160 PMCID: PMC6702856 DOI: 10.25259/jcis_105_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/02/2019] [Indexed: 12/20/2022] Open
Abstract
Mucocele of the appendix is rare and represents only the tip of the iceberg of underlying benign and malignant pathological processes. Intraoperative diagnosis is also tricky because the inflammation of the appendix often hides the tumor. The preoperative diagnosis is essential to differentiate appendiceal mucocele from acute appendicitis as the treatment varies from open surgical versus laparoscopic surgical approach and for decreasing intraoperative and postoperative morbidity and mortality rate. We present three cases of appendiceal mucocele. The purpose of this paper is to make the physicians aware of the entity, its associations and the effect on management. This review will provide radiologic and pathologic correlation for the preoperative diagnosis of benign and malignant causative processes and differential diagnostic considerations.
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Affiliation(s)
- Pranav Sharma
- Department of Radiology, Yale New Haven Health Bridgeport Hospital Bridgeport, CT USA
| | - Priti Soin
- Department of Pathology and Laboratory Medicine, Weill Cornell College of Medicine New York USA
| | - Manish Chugh
- Department of Pathology, Fortis Hospital Delhi India
| | - Pradeep Goyal
- Department of Radiology, St Vincent's Hospital Bridgeport, CT USA
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12
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Yoshimoto T, Nishi M, Yoshikawa K, Higashijima J, Tokunaga T, Nakao T, Kashihara H, Takasu C, Ishikawa D, Bando Y, Shimada M. A case of low-grade appendiceal mucinous neoplasm with invagination resected laparoscopically. Int Cancer Conf J 2017; 6:109-13. [PMID: 31149482 DOI: 10.1007/s13691-017-0285-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/12/2017] [Indexed: 12/15/2022] Open
Abstract
Low-grade appendiceal mucinous neoplasm (LAMN) is rare disease, and the absence of characteristic clinical symptoms makes preoperative diagnosis difficult. The strategy of treatment for LAMN has not been established. Surgical approach and lymph node (LN) dissection are still controversial. We herein present a case of LAMN with difficulties in making the preoperative diagnosis, which exhibited invagination and was treated by laparoscopy-assisted ileocecal resection with LN dissection. When cystic mass is detected in the bowel, LAMN or mucinous adenocarcinoma should be considered as a different diagnosis. And the laparoscopy-assisted ileocecal resection is a feasible operation for LAMN with careful procedure.
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13
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Mastoraki A, Sakorafas G, Vassiliu P, Contopoulou C, Arkadopoulos N. Mucocele of the Appendix: Dilemmas in Differential Diagnosis and Therapeutic Management. Indian J Surg Oncol 2015; 7:86-90. [PMID: 27065689 DOI: 10.1007/s13193-015-0463-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/01/2015] [Indexed: 02/08/2023] Open
Abstract
Mucocele of the appendix (AM) is a descriptive term for mucinous distension of the appendiceal lumen. It refers to the progressive retrograde dilatation of the vermiform appendix. Because of a lack of specific signs or due to its sometime quiet presentation, this condition is frequently diagnosed only at an advanced stage. We present three isolated cases of AM complicated by the development of acute inflammation of the appendix. Currently, the assessment of appendiceal lesions relies heavily on Ultra Sonography (US) as the primary diagnostic tool. This however may not always identify the origin of such a tumour. Therefore, additional investigative modalities are implemented. Despite recent research on the therapeutic strategies against appendiceal neoplastic disorders, surgical resection appears the only potentially curative approach. Accepted management includes appendectomy, right hemicolectomy, partial colectomy with debulking or palliative resection combined with additional chemotherapy. Even if laparoscopy has been successfully used to perform appendectomy, some concerns exist regarding its use in dealing with mucinous secreting lesions because of possible spillage of mucin intra-operatively. The aim of this investigation was to analyze all cases of AM complicated by the development of acute inflammation of the appendix presented in our institution. The relevant literature is briefly reviewed. Clinical features, diagnostic approach and management algorithm for appendiceal lesions are also discussed.
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Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Street, 12462 Athens, Chaidari Greece
| | - George Sakorafas
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Street, 12462 Athens, Chaidari Greece
| | - Pantelis Vassiliu
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Street, 12462 Athens, Chaidari Greece
| | - Christina Contopoulou
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Street, 12462 Athens, Chaidari Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Street, 12462 Athens, Chaidari Greece
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14
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Vatansev C, Simşek G, Küçükkartallar T. Single incision laparoscopic appendectomy with two port: a case of appendiceal mucocele. Indian J Surg 2013; 75:382-4. [PMID: 24426623 DOI: 10.1007/s12262-012-0689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 06/25/2012] [Indexed: 10/28/2022] Open
Abstract
Laparoscopic appendectomy for the neoplasm of the appendix remains a controversial subject in the literature. The main concern regarding laparoscopic treatment for the neoplasm of the appendix is incomplete resection and rupture of the tumor into the peritoneal cavity. There is a slight increase in the rate of invasion of the surgical margins in laparoscopic interventions. However, the prognosis of the neoplasm of the appendix treated with laparoscopic appendectomy is not different from an open surgical technique. A series of cases have been reported in the literature concerning the success rate of single-incision laparoscopic appendectomy used in the treatment of acute appendicitis. In our clinic, two-port laparoscopic appendectomy through a single incision was successfully performed on a 45-year-old male patient diagnosed with an appendiceal mucocele. Despite some concerns in the literature about laparoscopic treatment of neoplasms of the appendix, we suggest that single-incision laparoscopic appendectomy can be successfully performed in patients diagnosed with neoplasms of the appendix.
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Park KB, Park JS, Choi GS, Kim HJ, Park SY, Ryuk JP, Choi WH, Jang YS. Single-incision Laparoscopic Surgery for Appendiceal Mucoceles: Safety and Feasibility in a Series of 16 Consecutive Cases. J Korean Soc Coloproctol 2011; 27:287-92. [PMID: 22259743 PMCID: PMC3259424 DOI: 10.3393/jksc.2011.27.6.287] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 10/24/2011] [Indexed: 12/17/2022]
Abstract
Purpose The aim of this study was to evaluate the technical feasibility, safety, and oncological outcomes of transumbilical single-incision laparoscopic surgery in patients with an uncomplicated appendiceal mucocele. Methods A review of a prospectively collected database at the Kyungpook National University Hospital from January 2006 to September 2010 revealed that a series of 16 consecutive patients underwent single-incision laparoscopic surgery (SILS) for an appendiceal mucocele. Data regarding patient demographics, operating time, conversion, surgical morbidity, lateral lymph node status, and mid-term oncologic result were analyzed. Results The reported series consisted of 7 women (50%) and 9 men with a mean age of 61.6 years (range, 41 to 88 years). The mean operative time was 66.8 minutes (range, 33 to 150 minutes). Perioperative mortality and morbidity were 0% and 6.2%, respectively. Recovery after the procedure was rapid, and the mean hospital stay was 6.8 days (range, 3 to 22 days). Pathology revealed 12 lesions compatible with a mucinous cystadenoma and four others compatible with benign cystic tumors. All surgical margins were clear. In one case, an extra port had to be placed, and another case required conversion from SILS to a standard open laparotomy immediately after identification of the tumor because of a micro-perforation with focal mucin collection. With a median follow-up of 28.7 months, no re-admission or tumor recurrence, such as pseudomyxoma peritonei, was noted in 14 patients. Conclusion A single-port laparoscopic mucocelectomy should be safe and feasible and has the advantage of being a minimally invasive approach. Prospective controlled studies comparing SILS and conventional open surgery, with long-term follow-up evaluation, are needed to confirm the author's initial experience.
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Affiliation(s)
- Ki Bum Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
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