Diagnosis Of Appendiceal Mucocele Research Articles

Intestinal Intussusception Secondary to Appendiceal Mucocele, Report of a Case in A 53-Year-Old Female

Appendiceal intussusception is defined as the invagination of a portion of the appendix into its own lumen or into that of the cecum. In adults, the most common etiology is endometriosis (33%), followed by appendiceal mucocele (19%) and appendiceal inflammation (19%) [4]. Symptoms may be absent or mild. Lower abdominal pain or mass may be confused with appendicitis or tuboovarian mass in women. The diagnosis of appendiceal mucocele is often difficult preoperatively, even with the use of imaging. The definitive diagnosis is by histopathology. Treatment is surgical resection with care. Do not spill the contents, to prevent peritoneal pseudomyxoma with a poor prognosis [2]. In the present work, a 53-year-old female is reported with a 72-hour evolution of abdominal pain in the mesogastrium, accompanied by nausea and vomiting, normal vital signs on physical examination, without acute abdominal symptoms, with laboratories within normal parameters. , a computed tomography of the abdomen is taken which reports extensive intussusception at the ileocecal level which extends to the transverse colon, adjacent neoplastic etiology must be ruled out. An exploratory laparotomy was performed, finding intussusception of the ileum in the transverse colon with a 5 x 5 cm blind sentence, for which it was decided to perform a right hemicolectomy + mechanical lateral ileotransverse anastomosis. Patient with favorable evolution, hospitalized for 6 days.

Management of appendiceal mucocele diagnosed intraoperatively

Diagnosis of appendiceal mucocele is usually made intraoperatively in emergency operation theatre. It is crucial to recognize and treat this condition appropriately. This study reports management of such cases and their follow up. All cases of appendiceal mucocele diagnosed introperatively in patients undergoing emergency appendectomy at NMCH, Patna over duration of 1 year. Among 210 cases of appendectomy we found two cases of appendiceal mucocele. One patients underwent limited ileocaecal resection and appendectomy was done in the other case. Appendiceal mucocele should be recognized and treated appropriately. Limited ileocaecal resection along with taking care to avoid spillage of contents may suffice at primary surgery. Follow up can be done once histopathological diagnosis and margins are confirmed.

Endoscopic Appearance of Benign Versus Malignant Appendiceal Mucocele

Introduction: Appendiceal mucoceles are group of rare non-neoplastic or neoplastic cystic lesions characterized by an enlarged, mucus-filled appendix. Here we present two cases of incidentally found benign and malignant mucoceles. Case 1: A 62-year-old male underwent screening colonoscopy. He denied any gastrointestinal symptoms. Physical exam was unremarkable. The colonoscopy exam was normal except for a glossy, rounded, protruding mass arising from the appendiceal orifice that didn't flatten with air insufflations (Fig. 1-A). Overlying mucosa was normal. Probing with the biopsy forceps revealed a hard lesion. The biopsy revealed normal mucosa. Abdominal computed tomography (CT) scan showed a low attenuation, wellencapsulated round cystic mass in the right lower quadrant adjacent to the cecum with no other abnormalities (Fig. 1-B). The patient was diagnosed with appendiceal mucocele and underwent laparoscopic appendectomy. Intraoperative evaluation and surgical pathology confirmed the diagnosis of benign appendiceal mucocele (Fig. 1-C).Figure 1Case 2: 70-year-old Caucasian male with history of Barrett's esophagus was recently diagnosed with welldiff erentiated adenocarcinoma of the esophagus. As a part of tumor staging, he had abdominal CT scan which incidentally revealed cystic mass in the right lower quadrant adjacent to the cecum. So the patient underwent colonoscopy which showed ulcerated mass involving the appendiceal orifice measuring 1.5 cm in diameter (Fig. 2). The mass was highly suspicious for malignant mucocele. Multiple biopsies were obtained. The rest of the colon examination was not significant. Histopathology exam showed adenocarcinoma. The patient was referred for evaluation by multidisciplinary oncology team for further evaluation of the malignant esophageal and malignant appendiceal mucocele.Figure 2Conclusion: The diagnosis of appendiceal mucocele can be suspected during colonoscopic exam of the appendiceal orifice. Mucosal ulceration favors the diagnosis of malignant rather than benign appendiceal mucocele.

The Endosonographic Appearance of Appendiceal Mucoceles

Introduction: When a bulging appendiceal orifice is observed during surveillance colonoscopy, the possibility of appendiceal mucocele must be considered. Early recognition and diagnosis of appendiceal mucocele can prevent the dreaded complication of pseudomyxoma peritonei. The purpose of this retrospective study is to characterize the endosonographic features of mucinous cystadenomas of the appendix and to determine if this appearance can be used to help with surgical decision-making for lesions consistent with appendiceal mucoceles. Methods: We retrospectively reviewed all colonoscopies performed at our institution (University of Maryland Medical Center, Baltimore MD) over a 12-year period in which endoscopic ultrasound was also performed. Of those lesions suspicious for AM (n = 11), only those with a histologically-confirmed diagnosis of appendiceal mucinous cystadenoma were included. Results: Five patients had mucinous cystadenomaconfirmed after surgical resection. The mean age of the patients was 52 +/- 11.1 (+/- SEM). All abnormalities were first discovered incidentally on colonoscopy, and no patients were symptomatic.Endosonographically, 4 lesions were described as oval or round, while one lesion was irregular in shape. Diameters ranged from 11 mm to 27 mm. 5 lesions had well-defined borders without obvious layer(s) of origin. One lesion was described as homogeneous and anechoic, while another was homogenous and hypoechoic by description. The remaining 3 lesions were heterogeneous and predominantly hypoechoic, although anechoic areas were also noted in 2 of these lesions. No invasion of adjacent tissue was seen in any case.Fine needle aspiration was not performed prior to surgical referral. Conclusion: Appendiceal mucoceles (AM) can have a variable appearance on endoscopic ultrasound (EUS), but appear to have characteristic hypoechoic or anechoic attributes that might distinguish them from other lesions of the appendiceal orifice and cecum.

Distinguishing between acute appendicitis and appendiceal mucocele: is this possible preoperatively?

Mucocele of the appendix is an infrequent event, characterized by a cystic dilatation of the lumen. It is often diagnosed clinically from signs and symptoms of acute appendicitis or, if it is asymptomatic, as an incidental finding during ultrasonography, computed tomography, or laparotomy. We evaluated the histological data of patients who were believed to have mucocele of the appendix. These patients (n=23) were compared with sex- and age-matched control subjects (n=79) with appendicitis. The main reason for emergency surgery was lower right abdominal pain in 15 patients, and intestinal obstruction in three. Univariate analysis using sonography demonstrated that the larger appendiceal outer diameter was positively correlated with the diagnosis of appendiceal mucocele (p=0.001) and the mean white blood cell count was negatively correlated (p=0.023). In urine analysis, 41.7% of the mucocele patients and 10% of the appendicitis patients had microscopic hematuria, respectively (p=0.019). An outer diameter of 10mm or more was predictive of appendiceal mucocele diagnosis, with a sensitivity of 76.5%, specificity of 81%, positive predictive value of 76.5%, and negative predictive value of 94.12%. The overall diagnostic accuracy was 80.2%. One point was given for the presence of each of these factors to develop a new score. The resulting area under the receiver operator characteristic curve was 0.855 (95% CI 0.741-0.969) for the score. The histological examination of the specimens revealed mucocele in 15 cases, mucinous cystadenoma in seven cases and mucinous cystadenocarcinoma in one case. Twenty patients underwent appendectomy, and three patients were treated with right colectomy. A threshold 10-mm diameter of the appendix under compression is a useful preoperative measurement for differentiating between appendiceal mucocele and acute appendicitis. Microhematuria is simple test that can provide a significant role in supporting the clinical diagnosis of appendiceal mucocele in the emergency department.

Mucocele appendix: A rare differential diagnosis of pelvic mass

Mucocele of the appendix is a descriptive term that implies a dilated appendiceal lumen caused by abnormal accumulation of mucus. Mucocele is found in 0.2-0.3% of all appendectomy specimens. The male to female ratio is 1:4 and the average age at the time of diagnosis is over 50 years. Ultrasonography and computed tomography are useful tools for the diagnosis of appendiceal mucocele. Pre-operative diagnosis is a major component for minimizing intra operative and post-operative complications. We herein report a case of 40-year-old female presented as pelvic mass and this pose a diagnostic challenge

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

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.

巨大阑尾黏液囊肿：一例报道与诊疗分析

患者女，63岁，主诉右下腹部肿块3个月，门诊以结肠肿物收入院。查体在右下腹部触及13 cm × 8 cm × 6 cm 大小包块、质硬、活动、边界欠清。实验室检查：Hb 12.4 g/L、CEA 5.4 μg/L、CA125 24.4 U/mL、CA153 9.6 U/mL及CA19-9 < 2.0 U/mL。B超检查示下腹部条索状囊性包块(首先考虑肠道来源)；腹部CT扫描示盆腔右侧囊性占位性病变；结肠镜检查示回盲部外压性肿物。连硬麻醉下行剖腹探查，术中见右下腹部有一个15 cm × 8 cm × 5 cm腊肠样囊性肿物。术中冰冻病理组织学检查诊断为阑尾黏液囊肿。故决定行阑尾切除术，术后第4天痊愈出院。 A 63-year old female complained of right lower abdominal mass for 3 months, and she was admitted to hos- pital with a diagnosis colon tumor. On physical examination, an abdominal mass was found in her right quadrant, sized in 13 cm × 8 cm × 6 cm, hard, movable with clear margin. Laboratory examination revealed that Hb 12.4 g/L, CEA 5.4 μg/L, CA125 24.4 U/mL, CA153 U/mL and CA19-9 < 2.0 U/mL. A cord-like cystic mass in right abdominal cavity, primitive impression of gastrointestinal tumor, was detected by ultrasound examination, and CT scan demonstrated that a cystic occupation in right pelvic cavity, and exophytic tumor at cecum was found by fibrocolonoscopy. An exploratory laparotomy underwent by epidural anesthesia, a sausage-like tumor with size of 15 cm × 8 cm × 5 cm was seen at right abdominal cavity, and a diagnosis of appendiceal mucocele was made by intraoperative frozen pathological examination, then an appendectomy was performed, ad the patient recovered smoothly after operation and discharged on the 4th op- eration day.

Uncommon mimics of appendicitis: Giant mucocele

Appendiceal mucocele is an infrequent but well recognized entity that can present with a variety of clinical syndromes or can be asymptomatic and discovered incidentally. A 55 years old patient was admitted in the emergency department for acute right lower quadrant pain. A diagnosis of appendicitis was made. At operation an appendiceal mucocele was found. An appendectomy was performed. The diagnosis of appendiceal mucocele is an important one in that it can be associated with malignancies and other serious gastrointestinal, ovarian, and urological complications.

Mucocele of the appendix: An important clinical rarity

Mucocele is an uncommon pathology of the vermiform appendix that can be confused with acute appendicitis. We present a case of an appendiceal mucocele associated with subacute, intermittent right lower quadrant discomfort. The diagnosis of appendiceal mucocele is an important one in that it can be associated with malignancies and other serious gastrointestinal, ovarian, and urological complications.

A CASE OF APPENDICEAL MUCOCELE WITH A HIGH LEVEL OF CEA IN CYSTIC FLUID

Appendiceal mucocele is a relatively rare disease. We report a case of appendiceal mucocele with a high level of CEA in the cystic fluid. A 74-year-old woman was admitted to the hospital because of an ileocecal mass. Barium enema and colonoscopy revealed a submucosal tumor in the cecum. Abdominal computed tomography and ultrasonography showed a cystic mass in the ileocecum. Appendectomy was performed with the diagnosis of appendiceal mucocele. The appendix swelled to be 7.0×4.0cm in size. The CEA level of the cystic fluid was extremely high, 62577ng/ml. Pathologically, it was diagnosised as mucinous cystadenoma and immunohistochemical staining of CEA was positive.

A CASE OF PREOPERATIVELY DIAGNOSED APPENDICEAL MUCOCELE WITH A HIGH LEVEL OF CEA IN SERUM

Disease of the appendix are common for our clinical surgions, but tumorous lesions in the appendix are relatively rare. Recently we experienced a case of appendiceal mucocele with a high level of serum CEA which was diagnosed preoperatively. A 66-year-old woman was seen at the hospital because of epigastric pain. Upper gastrointestinal series was performed and a high level of CEA in serum was pointed out. Barium enema examination showed a submucosal tumor in the cecum without demonstrating the appendix. On abdominal US and CT examination, a cystic mass with homogenous content was observed in the pelvic cavity and a diagnosis of appendiceal mucocele was estabilished. Ileocecal, resection was performed. Pathologically, it was diagnosed as mucinous cystadenoma. Serum CEA level, which had been as 11.8ng/ml, went down to the normal range 3.2ng/ml after the operation. The patient is followed up on an ambulant basis. There has been no sigh of recurrence and seurm CEA level is kept within the normal range, as of 2 years after the operation.

A CASE REPORT OF APPENDICEAL MUCOCELE

We report a case of appendiceal mucocele which could be diagnosed preoperatively. A 40-year-old man was admitted to our hospital complaining of a palpable mass in the right lower part of the abdomen. Abdominal plain roentgenogram, barium enema, ultrasonogram and computed tomogram revealed calcified tumor in the ileocaecal region. The diagnosis of appendiceal mucocele was made and laparotomy was performed. The tumor coincided with the location of the appendix, ileocecal excision being carried out. The excised tumor had partially uneven wall, and was filled with gelatin-like substance. The pathohistological diagnosis was mucinous cystadenoma, borderline malignancy.Appendiceal mucocele is rare and difficult to be diagnosed preoperatively. We discussed the way of preoperative diagnosis and surgical procedures for appendiceal mucocele.