Ruptured appendiceal mucocele with pseudomyxoma peritonei

Appendiceal mucocele – a radiologist’s view

10.33699/pis.2021.100.6.266-270 ◽

2021 ◽

Vol 100 (6) ◽

Keyword(s):

Surgical Resection ◽

Pseudomyxoma Peritonei ◽

Rare Condition ◽

Appendiceal Mucocele

Appendiceal mucocele is an obstructive dilatation of the appendix, which results from the filling of its lumen with mucus. This is a rare condition that is asymptomatic in half of the patients. Its severity depends on the cause of appendiceal dilatation. In a small percentage of cases, the dilated appendix ruptures, leading to the development of serious complication; this is termed as pseudomyxoma peritonei. Due to the possibility of malignant etiology of the mucocele, surgical resection remains an essential part of the treatment.

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Appendiceal Mucocele Diagnosed in Patients with Inflammatory Bowel Disease Using Endoscopic Ultrasound

Case Reports in Medicine ◽

10.1155/2012/849892 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Uni Wong ◽

Peter Darwin

Keyword(s):

Inflammatory Bowel Disease ◽

Endoscopic Ultrasound ◽

Pseudomyxoma Peritonei ◽

Bowel Disease ◽

Early Recognition ◽

Appendiceal Mucocele ◽

Increased Risk ◽

Inflammatory Bowel ◽

High Index Of Suspicion ◽

Rare Group

When a bulging appendiceal orifice is observed during surveillance colonoscopy, the possibility of appendiceal mucocele must be considered. Appendiceal mucocele is a rare group of lesions characterized by mucinous distension of the appendiceal lumen with the dangerous potential to rupture, resulting in the development of pseudomyxoma peritonei. Early recognition and diagnosis of appendiceal mucocele can prevent the dreaded complication of pseudomyxoma peritonei but it requires a high index of suspicion. Patients with inflammatory bowel disease are at increased risk for colorectal neoplasm but neoplasm of the appendix is infrequently reported. We report two of the first cases of appendiceal mucoceles diagnosed in patients with inflammatory bowel disease using endoscopic ultrasound.

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Appendiceal mucocele secondary to torsion in an asymptomatic patient

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz241 ◽

2019 ◽

Vol 2019 (8) ◽

Cited By ~ 2

Author(s):

Nikhil Aggarwal ◽

Aman Bhargava

Keyword(s):

Surgical Resection ◽

Pseudomyxoma Peritonei ◽

Poor Prognosis ◽

Asymptomatic Patient ◽

Histopathological Diagnosis ◽

Appendiceal Neoplasm ◽

Diagnosis And Management ◽

Appendiceal Mucocele ◽

First Case

Abstract Torsion of the appendix associated with an appendiceal mucocele is extremely rare with just a few published cases. To our knowledge, we report the first case of appendiceal mucocele secondary to torsion in an asymptomatic patient. In this case, numerous adhesions were found attaching the tip of the appendix mucocele to the peritoneum contributing to torsion as well as a lack of evidence for appendiceal neoplasm. Complications of appendiceal mucocele include obstruction, intussusception and pseudomyxoma peritonei, which has a particularly poor prognosis. Clinicians should, therefore, consider prompt surgical resection for definitive histopathological diagnosis and management.

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Mucus Containing Cystic Lesions “Mucocele” of the Appendix: The Unresolved Issues

International Journal of Surgical Oncology ◽

10.1155/2015/139461 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Mohammad Ezzedien Rabie ◽

Mubarak Al Shraim ◽

Mohammad Saad Al Skaini ◽

Saad Alqahtani ◽

Ismail El Hakeem ◽

...

Keyword(s):

Pseudomyxoma Peritonei ◽

Mucinous Cystadenoma ◽

Right Hemicolectomy ◽

Malignant Potential ◽

Low Grade ◽

Uncertain Malignant Potential ◽

Appendiceal Mucocele ◽

Mucocele Of The Appendix ◽

Mucinous Tumours ◽

Mucinous Tumour

Background. Mucocele of the appendix is a rare condition, the pathological classification and management strategy of which have not been standardized yet.Aim. To report on our management of appendiceal mucocele, highlighting the pitfalls and possible means for avoiding them.Materials and Methods. Our registries were reviewed to retrieve cases of appendiceal mucocele, encountered in the period from July 2008 to May 2013.Results. We had 9 cases, three males and sex females, with a median age of 62 years. Abdominal ultrasound (US) and computerized axial tomography scan (CT) suspected the diagnosis in only one case each. Open appendectomy was done in two cases of mucinous cystadenoma with no further surgery performed, despite the positive margin in one. Laparoscopic appendectomy was done in three cases: mucinous cystadenoma in one case which needed no further surgery, mucinous cystadenocarcinoma with pseudomyxoma peritonei in another, and low grade mucinous tumour in a third case, and all needed subsequent right hemicolectomy. Exploratory laparotomy was done in three cases: of these, synchronous right hemicolectomy was done in one case of mucinous cystadenoma/?mucinous tumour of uncertain malignant potential; in the other two cases, appendectomy only was done for mucinous hyperplasia with carcinoid tumour of the appendix in one case and mucinous cystadenoma/?mucinous tumour of uncertain malignant potential in another. The 9th case was discovered upon laparoscopy for cholecystectomy; when pseudomyxoma peritonei arising from an appendiceal mucocele was found, laparoscopic appendectomy with peritoneal biopsy was then performed instead. Histopathologic diagnostic uncertainty was present in two cases of mucinous cystadenoma where mucinous tumour of uncertain malignant potential was an alternative possibility. Perioperative colonoscopy was performed in only one case and our follow-up programme was defective, with the longest period being 180 days.Conclusion. Mucocele of the appendix should be considered in the differential diagnosis of cystic lesions in the right lower abdomen. Owing to its rarity, it continues to intrigue the surgeon as well as the radiologist and pathologist alike. For mucinous cystadenocarcinoma, right hemicolectomy is usually needed, whereas for hyperplasia and cystadenoma, appendectomy usually suffices if the resection margins are free. For mucinous tumours of uncertain malignant potential and low grade mucinous tumours as well as pseudomyxoma peritonei, the decision is not as simple. As for laparoscopic surgery, no solid proof exists with or against its safety. Although not yet standardized, perioperative colonoscopy and regular follow-up to detect early recurrences should probably be part of the management plan.

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