Mucocele of the Appendix: Dilemmas in Differential Diagnosis and Therapeutic Management

Abstract

Mucocele of the appendix (AM) is a descriptive term for mucinous distension of the appendiceal lumen. It refers to the progressive retrograde dilatation of the vermiform appendix. Because of a lack of specific signs or due to its sometime quiet presentation, this condition is frequently diagnosed only at an advanced stage. We present three isolated cases of AM complicated by the development of acute inflammation of the appendix. Currently, the assessment of appendiceal lesions relies heavily on Ultra Sonography (US) as the primary diagnostic tool. This however may not always identify the origin of such a tumour. Therefore, additional investigative modalities are implemented. Despite recent research on the therapeutic strategies against appendiceal neoplastic disorders, surgical resection appears the only potentially curative approach. Accepted management includes appendectomy, right hemicolectomy, partial colectomy with debulking or palliative resection combined with additional chemotherapy. Even if laparoscopy has been successfully used to perform appendectomy, some concerns exist regarding its use in dealing with mucinous secreting lesions because of possible spillage of mucin intra-operatively. The aim of this investigation was to analyze all cases of AM complicated by the development of acute inflammation of the appendix presented in our institution. The relevant literature is briefly reviewed. Clinical features, diagnostic approach and management algorithm for appendiceal lesions are also discussed.

Incidental appendiceal mucinous neoplasm mimicking a left adnexal mass: A case report

“…Appendiceal mucocele describes the progressive dilatation of the vermiform appendix due to abnormal mucus accumulation in the lumen [ 1 ]. Mucus is retained as a result of lumen obstruction or hyperproduction due to benign (fecaliths, post inflammatory fibrosis, hyperplastic polyps, serrated adenomas) or malignant (low or high-grade appendiceal mucinous neoplasm, carcinoid tumors, mucinous adenocarcinomas) pathologies [ 2 ].…”

Long-term Results of Low Grade Appendiceal Mucinous Neoplasm (LAMN): A Retrospective Analysis of 24 Patients

“…The combined treatment modality including CRS and hyperthermic intraperitoneal chemotherapy has led to a 5-year survival ranging from 5% to 100% in lowgrade disease, and a survival ranging from 0 to 65% for high-grade disease. 2,4,[12][13][14][15][16][17] Surgical treatment of LAMN, with peritoneal mucin shedding, is controversial. The published literature shows that there is a significant prognostic difference between acellular and cellular mucin.…”

Appendiceal Mucocele: A Particular Clinical-Pathological Entity

“…Appendiceal mucocele is an uncommon affection accounting for 0.15 to 0.6% of appendectomies [4,5]. It affects preferably adults with an average age between 50 and 60 years [6,7], but can also affect children. It is a cystic dilatation of the appendix caused by the accumulation of mucus secretion intraluminally; this process is slow and progressive, without any sign of infection inside the organ.…”