Double trouble: a rare presentation of mucocele of appendix

Authors

DOI:

https://doi.org/10.18203/2349-2902.isj20231977

Keywords:

Mucocele, Appendix, Mucinous cystadenoma, Appendicitis, Pseudomyxoma peritonei

Abstract

Appendix is a blind ending tubular structure present at the convergence of the three tenia coli the base of the caecum. Most commonly presented to the out-patient department with features of appendicitis, but mucocele of the appendix secondary to malignant etiology is a rare clinical finding, more than half of the patients are asymptomatic in their clinical presentation. An accurate diagnosis and proper treatment protocols are necessary for its management. If mucocele of appendix is treated incorrectly may lead pseudomyxoma peritonei. A case of a 54-year-old man with right lumbar pain, duration of 1 week, clinical findings and ultrasonography (USG) abdomen reported as ill-defined collection in front of the psoas muscle (psoas abscess). Hence contrast-enhanced computed tomography (CECT) abdomen and pelvis was performed and was reported as features suggestive of mucocele of appendix and a right proximal ureteric calculus (8 mm) with hydronephrosis. After obtaining consent, patient underwent open appendectomy with right ureteroscopic lithotripsy (URSL) + double J stenting. Post-operative period was uneventful but histopathology of the specimen revealed a malignant origin. In patients presenting with a right sided abdominal pain, a broad spectrum of differential diagnosis should be considered and evaluated accordingly.

References

Rangarajan M, Palanivelu C, Kavalakat AJ, Parthasarathi R. Laparoscopic appendectomy for mucocele of the appendix. Report 8 cases. Indian J Gastroenterol. 2006;25(5):256-7.

Marudanayagam R, Williams GT, Rees BI. Review of the pathological results of 2660 appendectomy specimens. J Gastroenterol. 2006;41(8):745-9.

Ruiz-Tovar J, Teruel DG, Gastineires VM, Dehesa AS, Quindos PL, Molina EM. Mucocele of the appendix. World J Surg. 2007;31(3):542-8.

Smeenk RM, van Velthuysen ML, Verwaal VJ, Zoetmulder FA. Appendiceal neoplasms and pseudomyxomaperitonei: a population-based study. Eur J Surg Oncol. 2008;34(2):196-201.

Rokitansky CF. A Manual of Pathological Anatomy. Volume 2. Philadelphia: Blanchard & Lea, 1855. 2016.

Sugarbaker PH. Epithelial appendiceal neoplasms. Cancer J. 2009;15(3):225-35.

Aho A, Heinonen R, Lauren P. Benign and malignant mucocele of the appendix. Acta Chir Scand. 1973;139(4):392-400.

Higa E, Rosai J, Pizzimbono CA, Wise L. Mucosal hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma of the appendix. A re-evaluation of appendicealmucocele. Cancer. 1973;32(6):1525-54.

Dhage-Ivatury S, Sugarbaker PH. Update on the surgical approach to mucocele of the appendix. J Am Coll Surg. 2006;202(4):680-4.

Papaziogas B, Koutelidakis I, Tsiaousis P, Goula OC, Lakis S, Atmatzidis S, et al. Appendicealmucocele. A retrospective analysis of 19 cases. J Gastrointest Cancer. 2007;38(2-4):141-7.

Sugarbaker PH. Appendiceal Epithelial Neoplasms and Pseudomyxoma Peritonei, a Distinct Clinical Entity with Distinct Treatments. In: Bland KI, Büchler MW, Csendes A, Sarr MG, Garden OJ, Wong J, editors. Springer, London. 2009.

Francica G, Lapiccirella G, Giardiello C, Scarano F, Angelone G, De Marino F, et al. Giant mucocele of the appendix: clinical and imaging findings in 3 cases. J Ultrasound Med. 2006;25(5):643-8.

Sasaki K, Ishida H, Komatsuda T, Suzuki T, Konno K, Ohtaka M, et al. Appendiceal mucocele: sonographic findings. Abdom Imaging. 2003;28(1):15-8.

Caspi B, Cassif E, Auslender R, Herman A, Hagay Z, Appelman Z. The onion skin sign: a specific sonographic marker of appendiceal mucocele. J Ultrasound Med. 2004;23(1):117-21.

Benett GL, Tanpitukponqse TP, Macari M, Cho KC, Babb JS. CT diagnosis of mucocele of the appendix in patients with acute appendicitis. AJR Am J Roentgenol. 2009;192(3):103-10.

Hamilton DL, Stormont JM. The volcano sign of appendiceal mucocele. Gastrointest Endosc. 1989;35(5):453-6.

Zanati SA, Martin JA, Baker JP, Streutker CJ, Marcon NE. Colonoscopic diagnosis of mucocele of the appendix. Gastrointest Endosc. 2005;62(3):452-6.

Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH. Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases. Am J Surg Pathol. 2003;27(8):1089-103.

Khan MR, Ahmed R, Saleem T. Intricacies in the surgical management of appendiceal mucinous cystadenoma: a case report and review of the literature. J Med Case Rep. 2010;4:129.

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Published

2023-06-28

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Case Reports