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Torsion of Low-Grade Appendiceal Mucinous Neoplasm (LAMN): A Case Report
Hideo Kidogawa1, Ryo Nonomura1, Keizaburou Maruyama1
1Department of Surgery, Kitakyushu City Yahata Hospital, Kitakyushu, JPN.
Abstract:
A low-grade appendiceal mucinous neoplasm (LAMN) is a rare condition, occurring in 0.08-4.1% of appendectomy cases. Although this condition is frequently asymptomatic, it may occasionally result in acute complications, including torsion and rupture. We report the case of a 33-year-old male who presented with upper abdominal pain. Contrast-enhanced computed tomography (CECT) revealed a 3 cm cystic lesion in the appendix with 360° torsion at its base. Laparoscopic surgery confirmed the torsion, and the appendix was successfully resected without mucin spillage. Histopathological examination confirmed the diagnosis of LAMN. The postoperative course was uneventful, and the patient was discharged on postoperative day four. At 2.5 years follow-up, no recurrence was observed. This case highlights the rarity of LAMN torsion and the challenges in its preoperative diagnosis. The use of advanced imaging techniques, such as CECT, is crucial in identifying the torsion preoperatively, enabling timely surgical intervention. Furthermore, the successful laparoscopic resection without mucin spillage demonstrates the importance of meticulous surgical technique in preventing complications such as Pseudomyxoma peritonei (PMP), ensuring a favorable prognosis.
Insights
Low-grade appendiceal mucinous neoplasm (LAMN) is rare, but can cause complications like torsion. This case shows successful laparoscopic resection of a torsed appendix, preventing Pseudomyxoma Peritonei (PMP).
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Low-grade appendiceal mucinous neoplasm (LAMN) is a rare appendiceal tumor, diagnosed in 0.08-4.1% of appendectomies.
- While often asymptomatic, LAMN can lead to acute complications such as torsion or rupture.
- Appendiceal neoplasms require careful management to prevent spread and recurrence.
Observation:
- A 33-year-old male presented with upper abdominal pain.
- Contrast-enhanced computed tomography (CECT) revealed a 3 cm cystic appendiceal lesion with 360° torsion.
- Laparoscopic surgery confirmed the torsion and allowed for successful appendiceal resection.
Findings:
- Histopathological examination confirmed the diagnosis of LAMN.
- The laparoscopic resection was performed without mucin spillage, preventing Pseudomyxoma Peritonei (PMP).
- The patient experienced an uneventful postoperative recovery and had no recurrence at 2.5 years.
Implications:
- This case underscores the rarity of LAMN torsion and diagnostic challenges.
- Advanced imaging like CECT is vital for preoperative identification of appendiceal torsion.
- Meticulous laparoscopic technique is crucial for successful resection and prevention of PMP.
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