Diagnosis and Treatment of Mucinous Appendiceal Neoplasm Presented as Acute Appendicitis.

Ioannis Kehagias,Apollon Zygomalas,Pantelis Kraniotis,Thanasis Papandreou,Georgios Markopoulos

doi:10.1155/2016/2161952

Ioannis Kehagias, Apollon Zygomalas + Show 3 more

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https://doi.org/10.1155/2016/2161952

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Abstract

Appendiceal mucocele is a rare cause of acute abdomen. Mucinous appendiceal neoplasms represent 0.2–0.7% of all appendix specimens. The aim of this study is to report a case of a mucinous appendiceal neoplasm presented as acute appendicitis, discussing the clinical and surgical approach in the emergency setting. A 72-year-old female patient was admitted to the emergency department with a clinical examination indicative of acute abdomen. The patient underwent abdominal computed tomography scan which revealed a cystic lesion in the right iliac fossa measuring 8.3 × 5.2 × 4.1 cm, with calcified walls, and a mean density indicative of high protein content. The patient was taken to the operating room and a right hemicolectomy was performed. The postoperative course was unremarkable. The histopathological examination revealed a low-grade mucinous appendiceal neoplasm with negative regional lymph nodes. Ultrasound and CT are useful in diagnosing appendiceal mucocele and synchronous cancers in the emergency setting. The initial operation should include appendectomy and resection of the appendicular mesenteric fat along with any fluid collection for cytologic examination. During urgent appendectomy it is important to consider every mucocele as malignant in order to avoid iatrogenic perforation causing pseudomyxoma peritonei. Although laparotomy is recommended, the laparoscopic approach is not contraindicated.

Highlights

Appendiceal mucoceles (AM) or mucinous neoplasms are rare lesions characterized by a distended and mucus-filled appendix
The aim of this study is to report a case of giant appendiceal mucocele presented as acute appendicitis, discussing the clinical and surgical approach in the emergency setting
We presented the diagnostic and therapeutic approach in the emergency setting of a case of a giant appendiceal mucinous neoplasm presented as acute appendicitis in an elderly patient

Summary

Introduction

Appendiceal mucoceles (AM) or mucinous neoplasms are rare lesions characterized by a distended and mucus-filled appendix. They represent 0.2–0.7% of all appendix specimens [1,2,3,4,5]. The appendix epithelium contains many goblet cells and the accumulation of mucus is a typical finding Because of this mucus-producing epithelium, the most common epithelial tumors of the appendix are mucinous and begin as mucoceles [7]. The preoperative diagnosis of AM helps to avoid accidental iatrogenic perforation during surgery This is very important because it can lead to pseudomyxoma peritonei, characterized by peritoneal dissemination with high morbidity and mortality rate [9]. The aim of this study is to report a case of giant appendiceal mucocele presented as acute appendicitis, discussing the clinical and surgical approach in the emergency setting

Case Presentation

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Discussion