Surgical treatment of mucocele of the appendix: a systematic review and case report

Abstract

IntroductionAppendicular mucocele is a rare well-described clinico-pathological occurrence. It denotes an obstructive dilatation of the appendicular lumen by mucinous secretions.Case reportA 60-year-old patient presented with right lower abdominal pain and nausea for 2 years. Abdominal CT scan suggested a diagnosis of a appendicular mucocele. Following informed consent, surgical exploration revealed a cystic mass arising from the body of the appendix with inflamed walls with no evidence of perforation. Simple appendectomy was performed as the caecum and the mesenteric nodes were free of pathological involvement. The final diagnosis of mucinous cystadenoma was confirmed by histopathology. Postoperative course was uneventful. The patient was in good health during a four years regular follow-up.DiscussionAppendicular mucocele is a rare disease with vague symptoms. Abdominal imaging is an important diagnostic tool, but histopathology is the standard for definitive diagnosis. Surgery for benign appendicular mucoceles has an excellent long-term prognosis.

Appendiceal mucinous cystadenoma: a case report and review of the literature

“…7 Because preoperative diagnosis is difficult, the mucocele is generally intervened with a diagnosis of acute appendicitis and in most cases it is an incidental finding in surgery. 8 The definitive diagnosis is made through a pathological study of the surgical piece. 9 Histopathologically, appendiceal mucocele can be divided into 4 pathological types: simple mucocele, mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma.…”

Appendiceal mucocele secondary to torsion in an asymptomatic patient

“…Given the rarity of the condition, pre-operative diagnosis of an appendiceal mucocele is difficult. An appendiceal diameter of 15 mm or more has been determined as the threshold for a diagnosis of appendiceal mucocele with a sensitivity of 83% and specificity of 92% [2]. CT enables evaluation of the extent of the disease and usually shows a round, cystic, tubular, hypoattenuated mass.…”

“…Colonoscopy may reveal elevation of the appendiceal orifice with visible yellow mucous discharge as well as any synchronous or metachronous colon cancers [2]. Fine needle aspiration cytology is not recommended due to a risk of perforation and dissemination.…”

“…A right hemicolectomy is performed if malignancy is suspected based on imaging or intraoperative frozen section [2, 4]. In malignant cases, the risk of developing adenocarcinoma of the colon is greatly increased and therefore, follow-up and surveillance is recommended [8].…”

“…Mucocele of the appendix, a term first coined by Karl Freiherr von Rokitansky in 1842, describes an appendix that is grossly distended by mucus [1]. It is found in approximately 0.1–0.3% of appendectomy specimens and has non-specific symptomatology ranging from patients who are asymptomatic to having severe abdominal pain, often mimicking several common diseases [2, 3]. Mucocele formation is usually due to benign or malignant epithelial proliferation and less commonly due to inflammatory or obstructive causes.…”