Double trouble: a rare presentation of mucocele of appendix

Abstract

Appendix is a blind ending tubular structure present at the convergence of the three tenia coli the base of the caecum. Most commonly presented to the out-patient department with features of appendicitis, but mucocele of the appendix secondary to malignant etiology is a rare clinical finding, more than half of the patients are asymptomatic in their clinical presentation. An accurate diagnosis and proper treatment protocols are necessary for its management. If mucocele of appendix is treated incorrectly may lead pseudomyxoma peritonei. A case of a 54-year-old man with right lumbar pain, duration of 1 week, clinical findings and ultrasonography (USG) abdomen reported as ill-defined collection in front of the psoas muscle (psoas abscess). Hence contrast-enhanced computed tomography (CECT) abdomen and pelvis was performed and was reported as features suggestive of mucocele of appendix and a right proximal ureteric calculus (8 mm) with hydronephrosis. After obtaining consent, patient underwent open appendectomy with right ureteroscopic lithotripsy (URSL) + double J stenting. Post-operative period was uneventful but histopathology of the specimen revealed a malignant origin. In patients presenting with a right sided abdominal pain, a broad spectrum of differential diagnosis should be considered and evaluated accordingly.