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Calcified mucocele of the appendix presenting as ureteral obstruction
W H Risher1, J E Ray, T C Hicks
1Dept. of Colon and Rectal Surgery, Ochsner Clinic, New Orleans, LA 70121.
Abstract:
Mucocele of the appendix, a rare lesion, occurs in 0.3% of patients undergoing appendectomy. Only 46 cases of calcified mucocele have been reported. Complications reported include appendiceal intussusception, rupture resulting in acute abdomen, and infection. We report the case of a 74-year-old man with a calcified mucocele of the appendix that was discovered in the evaluation of a ureteral obstruction. During exploratory surgery, the patient was found to have a 6 x 5 cm appendiceal tumor and underwent a right ileocolectomy. Pathologic examination showed calcified mucous cystadenoma of the appendix. Calcification of a mucocele is believed to denote chronicity. Our case is the first report of ureteral obstruction secondary to calcified mucocele and the second calcified mucocele to be seen on computerized tomography. Calcified mucocele should be included in the differential diagnosis of any calcified tumor in the right lower quadrant.
Insights
A rare calcified appendiceal mucocele caused ureteral obstruction in a 74-year-old man. This case highlights the importance of considering appendiceal mucocele in the differential diagnosis of right lower quadrant calcified tumors.
Area of Science:
- Gastroenterology
- Urology
- Pathology
Background:
- Mucocele of the appendix is a rare condition, affecting 0.3% of patients undergoing appendectomy.
- Calcified appendiceal mucoceles are exceptionally rare, with only 46 cases previously reported.
- Potential complications include intussusception, rupture, and infection.
Observation:
- A 74-year-old male presented with ureteral obstruction.
- Computed tomography revealed a calcified appendiceal lesion.
- Exploratory surgery identified a 6 x 5 cm appendiceal tumor, diagnosed pathologically as a calcified mucous cystadenoma.
Findings:
- This case represents the first documented instance of ureteral obstruction secondary to a calcified appendiceal mucocele.
- Calcification within a mucocele is indicative of a chronic condition.
- The lesion was incidentally discovered during the investigation of ureteral obstruction.
Implications:
- Calcified appendiceal mucocele should be considered in the differential diagnosis of calcified right lower quadrant masses.
- This finding expands the known clinical presentations of appendiceal mucoceles.
- The case underscores the importance of thorough diagnostic evaluation for unexplained ureteral obstruction.