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Concomitant occurrence of appendiceal mucocele and ulcerative colitis: Case reports
Hafez Fakheri1, Zohreh Bari1, Mohammad Yaghoobi2
1Gut and liver Research Center, Non-communicable Research Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Background:
Appendiceal mucocele (AM) is a rare disease, manifested by accumulation of mucus in appendiceal lumen. The role of ulcerative colitis (UC) in the occurrence of appendiceal mucocele is not known. However, it is suggested that AM may be a presentation of colorectal cancer in IBD patients.
Case Presentation:
Here, we presented 3 cases of concomitant AM and ulcerative colitis. The first patient was a 55-year-old woman with 2-year history of left sided UC; the second person was a 52-year-old woman with 12-year history of pan-UC; and the third patient was a 60-year-old man with 11-year history of pan-colitis. They were all referred due to indolent right lower quadrant abdominal pain. Imaging evaluations suggested the presence of appendiceal mucocele and therefore, they all went under operation. Pathologic evaluation reported AM of mucinous cyst adenoma type; low-grade appendiceal mucinous neoplasm of appendix with intact serosa; and cyst-adenoma type AM for the three above-mentioned patients, respectively.
Conclusion:
Although concomitant occurrence of AM and ulcerative colitis is rare, regarding the potential of neoplastic changes in AM, physicians must keep in mind the diagnosis of AM in UC patients with non-specific abdominal RLQ pain or bulged appendiceal orifice during colonoscopy.
Insights
Appendiceal mucocele (AM), a rare mucus accumulation in the appendix, can occur with ulcerative colitis (UC). Physicians should consider AM in UC patients with right lower quadrant pain due to potential neoplastic changes.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Appendiceal mucocele (AM) is a rare condition characterized by mucus accumulation within the appendix.
- The association between ulcerative colitis (UC) and appendiceal mucocele remains unclear.
- Appendiceal mucocele may indicate colorectal cancer in patients with inflammatory bowel disease (IBD).
Observation:
- Three cases of concurrent appendiceal mucocele and ulcerative colitis are presented.
- Patients, aged 52-60, presented with indolent right lower quadrant abdominal pain.
- Imaging suggested appendiceal mucocele, leading to surgical intervention.
Findings:
- Pathological evaluations revealed appendiceal mucocele diagnoses including mucinous cystadenoma and low-grade appendiceal mucinous neoplasm.
- All three cases involved varying durations and severities of ulcerative colitis.
- The appendiceal mucinous neoplasms had intact serosa.
Implications:
- The concomitant occurrence of appendiceal mucocele and ulcerative colitis is infrequent but clinically significant.
- Physicians should maintain a high index of suspicion for appendiceal mucocele in UC patients presenting with non-specific right lower quadrant pain.
- Endoscopic findings such as a bulging appendiceal orifice in UC patients warrant further investigation for appendiceal mucocele.
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