The emphasis lies in accurate pathologic diagnosis, as the final treatment can differ depending on the malignant potential. Appendiceal mucoceles occur when there is an abnormal accumulation of mucin causing abnormal distention of the vermiform appendix due to various. This article is from case reports in gastroenterology, volume 5. We examined 38 appendectomies with diagnoses of mucocele, diverticulum, or adenoma to study the coincidence of appendiceal diverticula and appendiceal lowgrade mucinous neoplasms and to. The patients manifest a variety of symptoms, but can also be asymptomatic. Appendiceal mucocele am is a descriptive term for dilated appendiceal lumen, occasionally observed in either symptomatic or asymptomatic patients during colonoscopy. The appropriate management of an appendiceal mucocele. Laparoscopic appendectomy for acute appendicitis is frequently selected by patients and surgeons, and clinical studies show it to be a reasonable alternative.
Given the rarity of the condition, preoperative diagnosis of an appendiceal mucocele is difficult. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. Torsion secondary to an appendiceal mucocele appears similar to torsion of the ovary, with the appendiceal mucocele twisting around its own axis with a short section of normal appendix connecting the cystic mass to the caecum acting as a fulcrum. Appendiceal mucocele is a relative rare disease, but appropriate management is critical. The treatment modalities we adopted depended on the circum. While older literature on appendiceal mucoceles often failed to distinguish between benign and neoplastic lesions, the classification of appendiceal epithelial tumors of the appendix peritoneal mucin that is associated with a ruptured lamn or, less commonly, a ruptured benign appendiceal mucocele. Endometrial adenocarcinoma and mucocele of the appendix. Mucocele in the enlarged appendix cancer survivors network. Appendiceal mucoceles may be recognized at colonoscopy as a smooth bulbous submucosal lesion of the cecum with an impression formed by the appendiceal orifice. Pdf the mucocele of the appendix is an uncommon disorder which is often asymptomatic but sometimes causes. There is a lack of standardized treatment approach.
Mucocele of the appendix and pseudomyxoma peritonei. Appendiceal mucocele is a rare but wellrecognized entity that can mimic several common clinical syndromes or present as an incidental surgical or radiological finding. Appendiceal mucoceles are rare and are characterized by a distended, mucusfilled appendix. The most worrisome complication of this particular neoplasm is seeding of mucin into the adjacent peritoneum leading to pseudomyxoma peritonei pmp. The inferior part of the lesion is in contact with the normal right ovary. It is most commonly the result of epithelial proliferation, but can be caused. A mucocele appendix with wide base communicating with caecum is a rare presentation. Endoscopically, am looks like submucosal tumor of the cecum, and may mimic lipoma, gastrointestinal stromal tumor, or. We had a ct scan, xrays, and bloodwork about a week ago and got a clean bill of health from our oncologist. Laparoscopic appendectomy for mucocele of the appendix. Page 2 of 37 learning objectives 1 to illustrate the radiologic findings of appendiceal pathologies as shown with conventional radiology, us, ct and mr.
Mucoceles of the appendix are uncommon lesions in which the appendiceal lumen becomes distended with mucus. Etiological factors range from inflammatory to neoplastic, and right. Another rare cause found in literature is endometriosis, which may be established on the. Mural curvilinear interrupted calcification, suggestive of bowel origin is seen. Journal of clinical imaging science dilated appendix. The presence of wall calcification strongly supports a diagnosis of appendiceal mucocele, but this characteristic is seen in less than 50% of cases 5, 6. Mucocele of the appendix can also result from alterations in the cecum, such as fecal impaction, polyps or malignant neoplasms, which, in theory, can obstruct the appendiceal ostium.
Sometimes it is discovered accidentally and sometimes it resembles acute appendicitis. Symptoms range from right iliac fossa pain to mass per abdomen. Recognition at colonoscopy is important because it enables accurate diagnosis and directs management. Giant appendiceal mucinous cystadenoma treated by laparoscopy. A 38yearold man presented to clinic with recurrent right iliac fossa pain from a young age. The only problem isi dont have a right ovary as i had it removed when i had a hysterectomy over 6 years ago. Mucocele of the appendix is an aseptic dilatation secondary to obstruction. A gross or clinical descriptive term for dilation of the appendiceal lumen by mucus. The treatment for appendiceal mucocele is typically surgical resection. Mucoceles of the appendix are caused by excessive mucous production secondary to retention cyst simple 18%, mucosal hyperplasia 20%, mucinous. Lowgrade appendiceal mucinous neoplasm and endometriosis. Appendiceal mucocele is an obstructive dilatation of the appendix caused by intraluminal accumulation of mucoid material. They are a rare form of an appendiceal mass and develop from both benign and malignant processes. Next, i found an old ct scan report from 2005 where i had also gone to the doctor for this rightsided pain and it showed a 23 cm abnormality which the radiologist said appeared to be a mucocele of appendix.
Appendiceal mucocele is a very rare disease and found in only 0. Abstractappendiceal mucoceles are rare cystic lesions with an incidence of 0. 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. In this case study, laparoscopic surgery was used to resect an appendiceal mucocele caused by a nonperforated mucinous adenocarcinoma. Appendiceal mucocele is a rare disease and has a clinical picture that resembles acute appendicitis. It is most commonly the result of epithelial proliferation, but can. Appendicectomy is one of the most commonly performed surgical procedures. The most common nonneoplastic cause is a simple mucus retention cyst due to luminal obstruction. Cureus lowgrade appendiceal mucinous neoplasm in the. Appendiceal mucocele video journal and encyclopedia of. This therapy that can be safely used to treat appendiceal mucocele, as long as it is cautious.
A unique presentation of superinfected pseudomyxoma. Colonoscopy, abdominal pain, inflammatory bowel disease. Appendiceal mucocele is the result of obstruction of the appendiceal orifice with distention of the appendix caused by intraluminal accumulation of mucoid material. The preoperative clinical diagnosis of appendiceal mucoceles can therefore be difficult because of this lack of clinical.
Appendiceal mucocele is a rare entity with a nonspecific preoperative presentation and is diagnosed intraoperatively in a majority of cases. While older literature on appendiceal mucoceles often failed to distinguish between benign and neoplastic lesions, the classification of appendiceal epithelial tumors of the appendix peritoneal mucin that is associated with a ruptured lamn or, less commonly, a. Appendiceal mucocele is a cystic dilatation of the appendix due to. Surgical excision is the treatment of choice in benign mucocele. In both the endoscopy and the barium enema, the appendiceal mucocele can be detected as an elevation or a soft print located on the medial side of the cecal pole that suggests the presence of an extramucosal or extrinsic process fig. Up to 50% of patients with an appendiceal mucocele may be asymptomatic. The clinical symptoms vary and can mimic various chronic and acute abdominal conditions. Appendiceal mucocele may be inflammatory or have a neoplastic origin. Appendiceal mucocele am is a descriptive term for dilated appendiceal lumen, caused by abnormal accumulation of mucus. A 49yearold woman presented to our clinic with postmenopausal bleeding and no other symptom. Indeed, the intact removal of a mucocele represents a curative treatment.
Pdf mucocele of appendix develops due to obstructive dilatation of the appendix leading to intraluminal. The frequency of primary appendiceal tumours is reported to be 0. Only 12 cases of nonneoplastic appendiceal mucoceles caused by endometriosis have been previously. Appendix mucocele mimicking a complex ovarian cyst. Preoperative assessment and treatment of appendiceal mucocele. The typical ct appearance of appendiceal mucocele is a cystic, round, or tubular wellencapsulated mass, sometimes with calcifications in the expected location of the appendix. The histopathological classification, diagnosis and.
Pdf laparoscopic appendectomy for mucocele of the appendix. Appendiceal mucocelea rare case report sciencedirect. It affects more women than men, usually after the age of 50 year. The appendiceal mucocele refers to the cystic dilation of the appendicular lumen due to its obstruction and consequent accumulation of mucus.
We discuss diagnosis and differential diagnosis together with implications for patient management, covering low. Final pathology revealed a lowgrade appendiceal neoplasm with serrated architecture, and secondary acute inflammation of the appendix 5 cm in length x 0. A mucocele is an appendiceal mass characterized by hypersecretion of mucus contained within the appendix causing dilatation of the lumen. It mentionsenlarged appendix suspicious of mucocele our doctor had mentioned an enlarged appendix the last time we were there 6 months ago and didnt seem concerned. The epithelial lining of the appendix consists of abundant exocrine goblet cells, and thus most tumour types seen in appendiceal samples are mucus producing. The first group consists of a simple retention cyst secondary to proximal occlusion of the appendix by e. Preoperative assessment and treatment of appendiceal. Appendiceal mucoceles can be caused by nonneoplastic entities or mucinsecreting epithelial neoplasms fig 3. Ruptured mucocele of appendix volume 2 issue 4 2015 sushila ladumor, adham darwish, ala kamble and maysa abdul hafeez.
Excessive production of mucus by adenomatous tumours leads to the formation of. A wellcircumscribed tubular, elongated cystic lesion with a chicken drumstick appearance is seen in the right iliac fossa. Preoperative diagnosis of appendiceal mucocele, a rare disease of the vermiform appendix and an important item in the differential diagnosis of the appendiceal mass, is essential 7 to avoid the risk of rupture at surgery, with subsequent development of pseudomyxoma peritonei 8. A mucocele may result from appendiceal obstruction resulting in a retention cyst or, more commonly, may be a feature of a benign or a malignant neoplasm involving the appendix. Mucocele of the appendix is a term used to describe a dilated, mucinfilled appendix. Archives of clinical and medical case reports 3 2019. Appendiceal mucocele am is a rare entity that can present with a variety of clinical symptoms or occur as an incidental surgical finding. Colonoscopic diagnosis of mucocele of the appendix. The preoperative clinical diagnosis of appendiceal mucoceles can therefore be difficult because of this lack of clinical symptomotology. Management of appendiceal masses in a peripheral hospital. Appendiceal mucocele, first described by rokitansky, is a morphologic entity referring to localized or diffuse dilatation of the appendiceal lumen by abnormal accumulation of mucus. Endoscopically, am looks like submucosal tumor of the cecum, and may mimic lipoma, gastrointestinal stromal tumor, or neuroendocrine tumor. The coexistence of lowgrade mucinous neoplasms of the.
Appendiceal mucocele pdf mucocele of the appendix is a term used to describe a dilated, mucinfilled appendix. An appendiceal mucocele is a macroscopic description of an appendix abnormally distended by mucin 3. This lesion is lying vertically and is continuous with the terminal end of the appendix. An appendiceal mucocele is a wellknown but rare entity, where the appendiceal lumen is distended with mucinous material. Typically, the disease presents as suspected acute appendicitis, ovarian mass, abdominal distension, or ventral hernia. The coexistence of mucinous cystadenoma of the appendix and endometrial adenocarcinoma has not been reported before.
Appendiceal mucocele is a rare clinical entity, which is however quite often associated with mucinous ovarian tumor. A distended, mucousfilled appendix is known as an appendiceal mucocele. Mucoceles can develop secondarily to an obstruction, such as from a fecalith, scarring or, rarely, endometriosis. The course and prognosis of appendiceal mucoceles relate to their histologic subtypes. Cureus a rare case of lowgrade appendiceal mucinous. Appendiceal intussusception is an uncommon type of intussusceptions, accounting for only 0. Appendiceal mucoceles occur when there is an abnormal accumulation of mucin causing abnormal distention of the vermiform appendix due to various neoplastic or nonneoplastic causes. Mucocele of the appendix and pseudomyxoma peritonei may 1985, volume 144 number 5.
Our case represents a very rare presentation of superinfected pmp. A 49yearold woman presented with clinical signs, preoperative imaging, and intraoperative findings suggestive of acute appendicitis. Pseudomyxoma peritonei pmp is an uncommon condition characterized by diffuse mucinous material in the abdomen and pelvis, generally arising from a perforated epithelial neoplasm. Ureteral obstruction secondary to an appendiceal mucocele. Preoperative diagnosis and surgical approach of appendiceal. Minimally invasive surgery for appendiceal intussusception. An appendiceal mucocele refers to any lesion that is characterized by a distended, mucusfilled appendix. Retroperitoneal mucinous cystadenoma of the appendix mimicking. In view of persistent pain and recurrent admissions a ct scan was arranged which showed a dilated retrocaecal appendix suggesting recurrent appendicitis. It is characterized by mucoid accumulation in theappendix lumen and can present with diverse clinical features or just as an asymptomatic mass. For that reason, cases identified to have appendiceal mucocele should be assessed carefully with regards to colon neoplasms. The appendix is the most common intraabdominal location of mucoid collection. Appendiceal mucocele am is a descriptive term for dilated appendiceal lumen, occasionally observed in either symptomatic or asymptomatic. Lowgrade appendiceal mucinous neoplasm lamn is a rare malignancy with symptoms varying depending on the clinical manifestations.
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