Mucocele of the apendix is a rare clinical and pathological entity with a higher incidence in the female population, and non-specific symptomatology that includes more diagnoses including neoplastic and non-neoplastic causes of the apendix dilation and mucin proliferation. With obtained numerous variations in symptomatology, clinical picture, intraoperative presentation, surgical treatment and histopathological findings, the aim of this paper is an inspection into current knowledge of this disease, its histo-pathological characteristics, differential diagnosis and current treatment modalities. We present a patient with a clinical picture of the acute abdomen and numerous comorbidities. Ultrasound diagnostics indicated the presence of thin-walled dilatation of the small intestine, especially in the lower right quadrant, as well as the presence of free fluid in the peritoneal cavity. Apendectomy and removal of the mucocele and resection of the gangrenous sigmoid colon according to Hartmann were done. A definitive histo-pathological finding suggests ischemic colitis and retention mucocele of the apendix with normal mucosa. Histopathologically, four types of mucocele apendixes are distinguished, namely the retention mucinous cyst, mucosal hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. Surgical treatment is the method of choice in treating these tumors, either open or laparoscopic. Imperative is the preservation of the integrity of the entire mucocele, due to the possible dissemination of contents of the cyst and the subsequent development of pseudomyxoma peritonei.
Adult intussusception is a rare entity which is distinct from paediatric cases in incidence, aetiology, and management. It represents 5% of all intussusceptions and is the cause of 1% of all intestinal obstructions, 0,08% of all abdominal surgeries and 0,003-0,02% of all hospital admissions. Ileocolic intussusception in adults is a unique variant in which nearly 100% of cases have a malignant lead point. In our report, we described a case of a patient with ileocecal intussusception caused by a rare type of the gastrointestinal tumor. The female patient was admitted to hospital for occasional pain in the lower right quadrant of the abdomen followed by abdominal discomfort and appearance of blood in the stool. The result of CT scan of the abdomen and pelvis showed a tumor mass and intussusception at the ileocecal junction, which was confirmed peroperatively. Open right hemicolectomy was performed adhering to oncological principles. The final pathologic diagnosis indicated the gastrointestinal stromal tumor of the ileocecal valve. The diagnosis of intussusception in adults is delicate, and timely surgical treatment can be vital. Patients with the palpable abdominal mass, digestive tract obstruction, gastrointestinal bleeding, or lead point computed tomography must undergo a surgical examination. Given a high risk of malignancy, primary surgical resection using oncologic principles presents the best option for the treatment of ileocecal intussusception in adults.
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