Minimally invasive surgery for appendiceal intussusception caused by mucocele of the appendix: case report and review of the literature

Abstract

Appendiceal intussusception caused by mucocele of the appendix is extremely rare. In the current study, a 32-year-old woman was admitted to the department of general surgery of our hospital, complaining of persistent right, lower quadrant pain without an obvious cause for 17 hours. Physical examination indicated significant pain and tenderness in the right, lower abdominal quadrant. Blood analysis indicated that leukocyte count, the percentage of neutrophils and the serum C-reactive protein were increased. Abdominal and pelvic computed tomography revealed a well-encapsulated cystic mass surrounded by the caecum and intussusception. The appendiceal intussusception caused by mucocele of the appendix was revealed during the laparoscopic exploration. Appendectomy and partial cecectomy were conducted using the laparoscopic approach. Postoperative pathological examinations showed ileocecal intussusception and chronic inflammation, appendiceal mucocele and acute suppurative appendicitis. The patient showed satisfactory recovery that was observed during 15-months of follow-ups. This case highlights that laparoscopic appendectomy and partial cecectomy may be a beneficial, minimally invasive approach for appendiceal intussusception caused by mucocele of the appendix.

Laparoscopic Right Hemicolectomy for Appendiceal Mucocele

“…Appendiceal mucocele represents an abnormal dilatation of the appendix with intraluminal mucin accumulation with an incidence of less than 1% (5). Mucocele is often diagnosed in patients over 50 years of age (4), whereas women are more often affected by this disease (7).…”

“…There are still no clear guidelines for surgical treatment of mucocele, however, Dhage-Ivatury et al ( 16) and Kim et al (17) created a scheme for the selection of the type of surgery. Several factors, which should be considered before the surgery, are summarized in table 1 (5). Frozen section examination of resection margins and sentinel lymph node (SLN) from mesoappendix is often useful and necessary to assess the extent of surgery.…”

“…Patients may also present with invagination, torsion, bleeding or AM can be misdiagnosed as an adnexal mass (5) or rarely as a chronic tubo-ovarian abscess (6). In some cases, AM can be found accidentally on CT performed due to other reasons or during surgery (5). Herein, we present a case report of appendiceal mucocele in a postmenopausal female patient.…”

“…The clinical picture of AM can vary from asymptomatic mass in the right lower quadrant to symptoms of acute appendicitis. Patients may also present with invagination, torsion, bleeding or AM can be misdiagnosed as an adnexal mass (5) or rarely as a chronic tubo-ovarian abscess (6). In some cases, AM can be found accidentally on CT performed due to other reasons or during surgery (5).…”

Appendiceal intussusception

“…Evaluarea testelor de laborator de rutină sunt în limite normale și nu poate distinge invaginarea de alte cauze ale patologii abdominale [86]. În unele cazuri poate indica un răspuns moderat inflamator manifestat prin leucocitoză posibilă cu deviere spre stânga [22,28,41,48,49,69,70] și/sau creșterea nivelului de proteină C reactivă [27,28,52,54,69]. De asemenea au fost relevate nivelurile scăzute de hemoglobină cu anemie [25][26][27]31], acest simptom este mai frecvent detectat pentru pacienții cu suspiciune de neoplazie [96].…”