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Mucocoele of the appendix
Ernest Oyeh1, Josephine Nsaful2,3, Antoinette Bediako-Bowan2,3
1Akai House Clinic, Accra, Ghana.
Introduction:
Mucocoele of the appendix occurs in 0.2-0.7% of people in the world without any well-defined clinical symptoms. It occurs when there is an accumulation of mucous in the lumen of the appendix.
Case Presentation:
We present three cases: a 48-year-old male admitted to the emergency room with a one-day history of right iliac fossa pain. Abdominal examination was suggestive of acute appendicitis. The initial abdominal computerised tomography scan was reported as being unremarkable. At surgery, a firm tumour of the appendix was found, and a limited right hemicolectomy was done. Histopathology confirmed a mucocoele of the appendix with borderline mucinous histology.The second case is a 63-year-old man who presented with a one-year history of abdominal distension and weight loss. Previous abdominal ultrasound was suggestive of liver cirrhosis with significant ascitic fluid. Abdominal magnetic resonance imaging found an appendix mucocoele with infiltration of the omentum and scalloping of the liver surface suggestive of pseudomyxoma peritonei. A percutaneous biopsy of the omental mass confirmed metastatic mucinous adenocarcinoma of the appendix.The third case is a 68-year-old man who, during an annual medical check-up, had an incidental finding of a cystic right iliac fossa mass on ultrasound, confirmed on abdominopelvic computerised tomography scan to be an appendix mucocele. He had laparoscopic appendicectomy. The histopathological diagnosis confirmed a mucinous cystadenoma of the appendix.
Conclusion:
Preoperative diagnosis of appendiceal mucocoele is difficult and commonly discovered intraoperatively. The prognosis is good for the histologically benign type, but it is poor when malignant or peritoneal lesions are present.
Funding:
None declared.
Insights
Appendiceal mucocoele, a rare condition of mucus accumulation in the appendix, presents diagnostic challenges. Early detection and accurate histopathology are crucial for determining prognosis, especially differentiating benign from malignant types.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Oncology
Background:
- Appendiceal mucocoele is an uncommon condition, occurring in 0.2-0.7% of the population, characterized by mucus accumulation within the appendix.
- It often lacks distinct clinical symptoms, making preoperative diagnosis difficult and frequently leading to intraoperative discovery.
Observation:
- Three cases illustrate varied presentations: acute appendicitis mimic, abdominal distension with suspected pseudomyxoma peritonei, and incidental cystic mass.
- Diagnostic imaging modalities including CT and MRI played key roles in identifying the mucocoele and associated findings.
Findings:
- Histopathological examination confirmed diverse diagnoses, including borderline mucinous histology, metastatic mucinous adenocarcinoma, and benign mucinous cystadenoma.
- The cases highlight the spectrum of appendiceal mucocoele, from incidental findings to advanced malignancy with peritoneal spread.
Implications:
- Accurate preoperative diagnosis of appendiceal mucocoele remains challenging, underscoring the importance of intraoperative assessment.
- Prognosis is strongly correlated with histological findings, with benign types offering a good outlook and malignant or peritoneal involvement indicating a poor prognosis.
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