Appendicular Mucosal Intussusception into the Cecum Secondary to an Intramural Mucinous Cystoadenoma of the Appendix

Abstract

2 41-year-old woman with arterial hypertension had evere, episodic abdominal pain in the right lower quadant and weight loss of 2 kg. A large tender mass was alpable in the right lower quadrant. Abdominal ultraound and colonoscopy were normal. A CT scan of the bdomen and pelvis showed a heterogeneous cyst with alcifications located in the wall of the cecum (A,*), uggesting an appendiceal mucocele. The patient was eferred to our hospital for reevaluation because her ymptoms persisted. She had normal blood pressure and emperature of 37.4°C. The abdomen was distended nd tender in the right lower quadrant, where a large ass was palpable. A new colonoscopy showed a mass of cm in the cecum without alteration of the mucosa (B). iopsies showed normal mucosa. Abdominal pain inreased in subsequent days and was associated with abominal distention and nausea. At operation a mass of pproximately 12 cm was found, composed of distal ileum hat intussuscepted into the cecum with inflammatory satllite lymph nodes (C, a). An uneventful right colectomy ith ileotransverse anastomosis was performed. Pathologic examination of the specimen showed a ound tumor with a smooth surface of approximately 4 m (D, b) located at the appendiceal orifice. On section cystic lesion 10 3.9 3.5 cm was observed origiating in the appendiceal wall (E, a, b), between the uscularis mucosae and the muscular propria. This cysic tumor dilated the entire appendix producing the inA