Annals of Coloproctology

Case Report

Benign GI diease,Rare disease & stoma

Impending Rupture With a Twisted Huge Appendiceal Mucocele Treated With Totally Laparoscopic Resection: A Case Series: Hong-min Ahn, Si-Hak Lee; Ann Coloproctol. 2021;37(Suppl 1):S34-S38. Published online June 29, 2021; DOI: https://doi.org/10.3393/ac.2020.00150.0021

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Torsion of the appendix is rare, and appendiceal mucocele can be one of its causes. The first case was of a 49-year-old man who visited the emergency room (ER) for abdominal pain. Abdominal computed tomography (CT) showed appendiceal mucocele with suspected torsion and rupture. The patient underwent laparoscopic exploration and appendectomy. The second case was of a 69-year-old man who visited the ER for epigastric pain. Abdominal CT showed suspicious appendiceal mucocele with ischemic change, indicating torsion of the appendix. The twisted appendix was successfully removed by laparoscopic exploration. An appendiceal mucocele is one of the causes of twisted appendix. With torsion, the mucocele can be diagnosed as rupture by ischemia which may lead to pseudomyxoma peritonei. For this reason, open laparotomy has traditionally been preferred. However, an unruptured appendiceal mucocele or impending rupture with torsion of the appendiceal mucocele can be treated with totally laparoscopic surgery.

Citations

Citations to this article as recorded by

Uncommon cause of acute appendiceal torsion mucocele
Munyaradzi Gift Nyandoro, Vignesh Kumar Palanisamy, Rajesh Kumar Singh
BMJ Case Reports.2022; 15(7): e249175. CrossRef
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Suk Jun Lee, Ji Hae Nahm, Jeonghyun Kang, Seung Hyuk Baik, Eun Jung Park
International Journal of Surgery Case Reports.2022; 99: 107665. CrossRef

Original Articles

Single-incision Laparoscopic Surgery for Appendiceal Mucoceles: Safety and Feasibility in a Series of 16 Consecutive Cases: Ki Bum Park, Jun Seok Park, Gyu-Seog Choi, Hye Jin Kim, Soo Yeun Park, Jong Pil Ryuk, Won Ho Choi, You Seok Jang; J Korean Soc Coloproctol. 2011;27(6):287-292. Published online December 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.6.287

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Abstract PDF

Purpose

The aim of this study was to evaluate the technical feasibility, safety, and oncological outcomes of transumbilical single-incision laparoscopic surgery in patients with an uncomplicated appendiceal mucocele.

Methods

A review of a prospectively collected database at the Kyungpook National University Hospital from January 2006 to September 2010 revealed that a series of 16 consecutive patients underwent single-incision laparoscopic surgery (SILS) for an appendiceal mucocele. Data regarding patient demographics, operating time, conversion, surgical morbidity, lateral lymph node status, and mid-term oncologic result were analyzed.

Results

The reported series consisted of 7 women (50%) and 9 men with a mean age of 61.6 years (range, 41 to 88 years). The mean operative time was 66.8 minutes (range, 33 to 150 minutes). Perioperative mortality and morbidity were 0% and 6.2%, respectively. Recovery after the procedure was rapid, and the mean hospital stay was 6.8 days (range, 3 to 22 days). Pathology revealed 12 lesions compatible with a mucinous cystadenoma and four others compatible with benign cystic tumors. All surgical margins were clear. In one case, an extra port had to be placed, and another case required conversion from SILS to a standard open laparotomy immediately after identification of the tumor because of a micro-perforation with focal mucin collection. With a median follow-up of 28.7 months, no re-admission or tumor recurrence, such as pseudomyxoma peritonei, was noted in 14 patients.

Conclusion

A single-port laparoscopic mucocelectomy should be safe and feasible and has the advantage of being a minimally invasive approach. Prospective controlled studies comparing SILS and conventional open surgery, with long-term follow-up evaluation, are needed to confirm the author's initial experience.

Citations

Citations to this article as recorded by

Single-incision laparoscopic surgery compared to conventional laparoscopic surgery for appendiceal mucocele: a series of 116 patients
Ho Seung Kim, Han-Gil Kim, Seung Yoon Yang, Yoon Dae Han, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim, Min Soo Cho
Surgical Endoscopy.2022; 36(1): 244. CrossRef
Mucinous appendiceal neoplasm: A case report
Alexandru Chirca, Lucian Negreanu, Andreea Iliesiu, Radu Costea
World Journal of Clinical Cases.2021; 9(7): 1728. CrossRef
Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach
In Soo Cho, Sung Uk Bae, Hye Ra Jung, Kyung Sik Park, Woon Kyung Jeong, Seong Kyu Baek
Annals of Coloproctology.2021; 37(2): 125. CrossRef
Surgical Outcomes of Single-Port Laparoscopic Surgery Compared With Conventional Laparoscopic Surgery for Appendiceal Mucinous Neoplasm
In Jun Yang, Minseol Seo, Heung-Kwon Oh, Jeehye Lee, Jung Wook Suh, Duck-Woo Kim, Sung-Bum Kang
Annals of Coloproctology.2021; 37(4): 239. CrossRef
Appendiceal Mucocele - A Review of Literature with a Case Report
Berislav Vekic, Rade Markovic, Aleksandar Cvetkovic, Bojan Stojanovic, Marko Spasic, Nenad Markovic, Mladen Pavlovic, Dusica Petrovic, Bojan Milosevic, Jasna Jevdjic, Maja Vulovic, Dalibor Jovanovic, Slobodanka Mitrovic
Serbian Journal of Experimental and Clinical Research.2021;[Epub] CrossRef
The American Society of Colon and Rectal Surgeons, Clinical Practice Guidelines for the Management of Appendiceal Neoplasms
Sean C. Glasgow, Wolfgang Gaertner, David Stewart, Jennifer Davids, Karim Alavi, Ian M. Paquette, Scott R. Steele, Daniel L. Feingold
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Junko Mukohyama, Yasuo Sumi, Kiyonori Kanemitsu, Hiroshi Hasegawa, Masashi Yamamoto, Shingo Kanaji, Yoshiko Matsuda, Kimihiro Yamashita, Takeru Matsuda, Taro Oshikiri, Tetsu Nakamura, Satoshi Suzuki, Yoshihiro Kakeji
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Minimally invasive appendectomy for resection of appendiceal mucocele: Case series and review of the literature
Sonia T. Orcutt, Daniel A. Anaya, Mokenge Malafa
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Diagnosis and Treatment of Mucinous Appendiceal Neoplasm Presented as Acute Appendicitis
Ioannis Kehagias, Apollon Zygomalas, Georgios Markopoulos, Thanasis Papandreou, Pantelis Kraniotis
Case Reports in Oncological Medicine.2016; 2016: 1. CrossRef
Recommendations in the management of epithelial appendiceal neoplasms and peritoneal dissemination from mucinous tumours (pseudomyxoma peritonei)
P. Barrios, F. Losa, S. Gonzalez-Moreno, A. Rojo, A. Gómez-Portilla, P. Bretcha-Boix, I. Ramos, J. Torres-Melero, R. Salazar, M. Benavides, T. Massuti, E. Aranda
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IV. Les recommandations

Journal de Chirurgie Viscérale.2014; 151(6): S15. CrossRef
Distinguishing between acute appendicitis and appendiceal mucocele: is this possible preoperatively?
B. Saylam, C. E. Güldoğan, F. Coşkun, V. Vural, B. Çomçalı, M. Tez
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Appendiceal Mucocele.: Lim, Young Chul , Choi, Dae Hwa , Cho, Hong Rae , Ko, Byung Kyun , Nam, Chang Woo , Nah, Yang Won , Kim, Gyu Yeol; J Korean Soc Coloproctol. 2004;20(6):339-343.

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Abstract PDF: PURPOSE
An appendiceal mucocele refers to an abnormal dilatation of the appendiceal lumen by mucus. It is a rare clinical entity with a reported prevalence rate of 0.2~0.3% of all appendectomies. The purpose of our study was to identify the clinical characteristics of and the proper surgical management for appendiceal mucoceles.
METHODS
The hospital records of 24 eligible patients were reviewed. We analyzed demographic data, and pathological and clinical data.
RESULTS
There was a significant difference in size (P<0.009) between simple mucoceles (mean, 1.95 cm) and cystadenomas (mean, 3.6 cm). While ultrasonography was the most commonly used test to establish the diagnosis (14 patients), computed tomography and colonoscopy also provided fundamental information in 5 and 2 patients, respectively. An appendectomy was performed in most cases (20 cases, 83%). A cecectomy was performed in 3 cases, and an ileocecal resection was performed in only one case. Among the cases requiring a cecectomy, a laparoscopic cecectomy was performed in one case. A synchronous tumor was present in 5 cases. Three patients had gastric cancer, 1 patient had gallbladder cancer, the other one had endometriosis.
CONCLUSIONS
Our study shows that appendiceal mucoceles most frequently present as acute appendicitis and that preoperative diagnosis is difficult to make. All mucoceles should probably be removed to eliminate the chance of progression to malignancy. Also of note was the elevated incidence of associated neoplasms, especially gastrointestinal carcinomas. Some recommend surveillance colonoscopy in patients with a diagnosis of an appendiceal mucocele. We had three cases accompanied by gastric malignancy. Therefore, we suggest that surveillance gastrofiberscopy may be indicated.

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