Prudent planning in management of mucocele of appendix

Appendiceal mucocele is a rare obstructive dilatation of the appendix caused by intraluminal accumulation of mucoid material. Having no typical clinical picture, patients presenting with lower right quadrant abdominal pain are sometimes mistaken for acute appendicitis. An untreated mucocele may progress leading to high mortality.

A 47-year-old female presented with dull pain in the right lower abdomen, associated with generalized weakness and nausea since 6 months. Other than mild tenderness over the right iliac fossa. Physical and laboratory examination was insignificant. Abdominal sonography was doubtful between appendicular abscess and mucocele appendix. Dual contrast CT scan of abdomen was highly suggestive of an appendicular mucocele.

The patient had a vertical midline incision exploratory laparotomy done and a cystic mass measuring 7 × 4 × 4 cm³ was found arising from the body of appendix. With suspicion of malignancy because of size, right hemicolectomy with ileotransverse anastomosis was done. Histopathological examination showed features of low grade appendiceal mucinous neoplasm.

Pre-operative diagnosis of appendicular mucocele is difficult, nevertheless, it is important for the selection of the appropriate surgical procedure in order to prevent intra-operative complications and early surgical intervention has excellent long-term prognosis.