Appendiceal mucocele secondary to torsion in an asymptomatic patient

Abstract

Torsion of the appendix associated with an appendiceal mucocele is extremely rare with just a few published cases. To our knowledge, we report the first case of appendiceal mucocele secondary to torsion in an asymptomatic patient. In this case, numerous adhesions were found attaching the tip of the appendix mucocele to the peritoneum contributing to torsion as well as a lack of evidence for appendiceal neoplasm. Complications of appendiceal mucocele include obstruction, intussusception and pseudomyxoma peritonei, which has a particularly poor prognosis. Clinicians should, therefore, consider prompt surgical resection for definitive histopathological diagnosis and management.

Impending Rupture With a Twisted Huge Appendiceal Mucocele Treated With Totally Laparoscopic Resection: A Case Series

“…However, some studies assume that secondary torsion of the appendix, like our presented cases, could be similar to ovarian torsion, which twists around its own axis, with a fulcrum of the short segment of the normal appendix between the cystic mass and cecum [9,10]. Histologically, appendiceal mucocele can be categorized into 4 causes: retention cyst, mucosal hyperplasia, LAMN or mucinous cystadenoma, and mucinous cystadenocarcinoma [4][5][6]9]. More than half of mucinous tumors (52% to 58%) are considered malignant tumors of the appendix [5,6].…”

“…The morphology of the appendix such as long appendix, fan-shaped mesoappendix, or appendix with narrow base may increase the risk of primary torsion [ 1 , 2 ]. However, some studies assume that secondary torsion of the appendix, like our presented cases, could be similar to ovarian torsion, which twists around its own axis, with a fulcrum of the short segment of the normal appendix between the cystic mass and cecum [ 9 , 10 ].…”

“…Histologically, appendiceal mucocele can be categorized into 4 causes: retention cyst, mucosal hyperplasia, LAMN or mucinous cystadenoma, and mucinous cystadenocarcinoma [ 4 - 6 , 9 ]. More than half of mucinous tumors (52% to 58%) are considered malignant tumors of the appendix [ 5 , 6 ].…”

Torsion of a mucocele of the veriform appendix: report of a case

“…One should always be aware to avoid rupture of the appendicular mucocele, because the spread of mucinous content throughout the abdominal cavity can provoke pseudomyxoma peritonei [ 4 ]. This condition has a poor 10 year survival rate of 10–30% [ 1 ]. In case of mucinous cystadenocarcinoma, a right hemicolectomy is required with lymphadenectomy [ 7 ].…”

“…A mucocele of the appendix refers to an appendix that is distended by mucus and transformed in a mucus-filled sac [ 1 , 2 ]. The term mucocele was first used in 1842 by Karl Freiherr von Rokitansky and an appendicular torsion was first described in 1918 [ 1 , 3 ]. Appendicular torsion is rare and patients present themselves often with complaints mimicking acute appendicitis.…”