Related Experiment Video
Updated: Mar 26, 2026
Murine Appendectomy Model of Chronic Colitis Associated Colorectal Cancer by Precise Localization of Caecal Patch
Published on: August 24, 2019
Distinguishing between acute appendicitis and appendiceal mucocele: is this possible preoperatively?
B Saylam1,2, C E Güldoğan3, F Coşkun4
1Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey. mdbsaylam@yahoo.com.
Purpose:
Mucocele of the appendix is an infrequent event, characterized by a cystic dilatation of the lumen. It is often diagnosed clinically from signs and symptoms of acute appendicitis or, if it is asymptomatic, as an incidental finding during ultrasonography, computed tomography, or laparotomy.
Methods:
We evaluated the histological data of patients who were believed to have mucocele of the appendix. These patients (n = 23) were compared with sex- and age-matched control subjects (n = 79) with appendicitis.
Results:
The main reason for emergency surgery was lower right abdominal pain in 15 patients, and intestinal obstruction in three. Univariate analysis using sonography demonstrated that the larger appendiceal outer diameter was positively correlated with the diagnosis of appendiceal mucocele (p = 0.001) and the mean white blood cell count was negatively correlated (p = 0.023). In urine analysis, 41.7 % of the mucocele patients and 10 % of the appendicitis patients had microscopic hematuria, respectively (p = 0.019). An outer diameter of 10 mm or more was predictive of appendiceal mucocele diagnosis, with a sensitivity of 76.5 %, specificity of 81 %, positive predictive value of 76.5 %, and negative predictive value of 94.12 %. The overall diagnostic accuracy was 80.2 %. One point was given for the presence of each of these factors to develop a new score. The resulting area under the receiver operator characteristic curve was 0.855 (95 % CI 0.741-0.969) for the score. The histological examination of the specimens revealed mucocele in 15 cases, mucinous cystadenoma in seven cases and mucinous cystadenocarcinoma in one case. Twenty patients underwent appendectomy, and three patients were treated with right colectomy.
Conclusions:
A threshold 10-mm diameter of the appendix under compression is a useful preoperative measurement for differentiating between appendiceal mucocele and acute appendicitis. Microhematuria is simple test that can provide a significant role in supporting the clinical diagnosis of appendiceal mucocele in the emergency department.
Insights
Appendiceal mucocele, a rare appendix condition, can be diagnosed using imaging and urine tests. A 10 mm or larger diameter on ultrasound is highly indicative of mucocele, aiding in differentiating it from appendicitis.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Diagnostic Imaging
Background:
- Mucocele of the appendix is an uncommon condition involving cystic dilatation of the appendiceal lumen.
- Diagnosis often occurs during imaging for suspected appendicitis or as an incidental finding.
Purpose of the Study:
- To evaluate histological data of patients with suspected appendiceal mucocele.
- To compare these patients with a control group diagnosed with appendicitis.
Main Methods:
- Histological analysis of 23 patients with suspected mucocele and 79 controls with appendicitis.
- Sonographic evaluation focusing on appendiceal outer diameter and white blood cell count.
- Urine analysis for microscopic hematuria.
Main Results:
- Larger appendiceal outer diameter (≥10 mm) and lower white blood cell count correlated with mucocele diagnosis.
- Microscopic hematuria was present in 41.7% of mucocele patients vs. 10% of appendicitis patients (p=0.019).
- A 10 mm diameter threshold showed high diagnostic accuracy (80.2%) for appendiceal mucocele.
Conclusions:
- A 10 mm appendiceal diameter under compression is a valuable preoperative marker to distinguish mucocele from appendicitis.
- Microhematuria can significantly support the clinical diagnosis of appendiceal mucocele in emergency settings.
Related Concept Videos
01:22Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:19Abdominal Regions and Quadrants
The simpler quadrants approach, which is more commonly used in medicine, subdivides the cavity with one horizontal and one vertical line that intersects at the patient's umbilicus (navel). The four...
01:25Assessment of the Abdomen I: Inspection and Auscultation
The abdominal examination is a cornerstone of clinical medicine, serving as a critical tool in diagnosing various gastrointestinal (GI) diseases. It involves a systematic approach that includes inspection and auscultation, each with distinct yet complementary roles in assessing the abdomen. This article will delve into these two primary methods healthcare professionals use to examine the abdomen.
Inspection of the Abdomen
The first step in any abdominal examination is inspection....