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Impending Rupture With a Twisted Huge Appendiceal Mucocele Treated With Totally Laparoscopic Resection: A Case Series
Hong-Min Ahn1,2, Si-Hak Lee1,2,3
1Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
Abstract:
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.
Insights
Appendiceal mucocele can cause appendix torsion, a rare condition. Laparoscopic surgery is effective for unruptured or impending rupture cases, offering a minimally invasive treatment option.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Appendix torsion is a rare surgical emergency.
- Appendiceal mucocele is an uncommon condition involving mucus accumulation within the appendix.
Observation:
- Two cases of appendiceal mucocele with torsion are presented.
- Patients presented with abdominal and epigastric pain.
- Abdominal CT scans revealed appendiceal mucocele with signs of torsion, ischemia, and suspected rupture.
Findings:
- Torsion of the appendix secondary to appendiceal mucocele can mimic rupture.
- Laparoscopic appendectomy was successfully performed in both cases.
- Early diagnosis and intervention are crucial to prevent complications like pseudomyxoma peritonei.
Implications:
- Laparoscopic surgery is a viable and effective treatment for unruptured or impending torsion of appendiceal mucocele.
- Minimally invasive approaches can be considered, challenging the traditional preference for open laparotomy.
- Accurate preoperative diagnosis via imaging is vital for appropriate surgical planning.
