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Apendiceal Mucocele
Apendiceal Mucocele
3rd Surgical Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
“Octavian Fodor” Regional Institute Of Gastro-Enterology and Hepatology, Cluj-Napoca, Romania
Rezumat Abstract
Few cases of intestinal obstruction complicating an
Ocluzie intestinalã prin mucocel apendicular invadant în
appendiceal mucocele has been reported. We report the case
douã anse enterale
of a young woman who presented to emergency room with
Puåine cazuri de ocluzie intestinalã secundarã unui mucocel diffusely abdominal pain, nausea, vomiting and disruption of
apendicular sunt citate în literatura de specialitate. Prezentãm bowel movements. Her abdomen was mildly distended and
cazul unei paciente care se prezintã în urgenåã pentru dureri tympanic. A flat film of the abdomen revealed dilated small
abdominal difuze, greåuri, vãrsãturi æi întreruperea tranzitului bowel loops with air-fluid levels suggestive of small bowel
intestinal. Examenul obiectiv: abdomen destins, sensibil difuz obstruction. She also had leukocytosis. An emergency
la palparea profundã, cu timpanism la percuåie. Radiografia operation was performed under the diagnosis of intestinal
abdominalã pe gol evidenåiazã anse enterale dilatate cu nivele obstruction. The intraoperatory findings showed a tumoral
hidro-aerice, iar probele de laborator prezenåa leucocitozei. Se appendiceal mass permeated into the ileum in two distinct
intervine chirurgical de urgenåã cu diagnosticul de ocluzie points, causing an enteral stenosis. We performed an
intestinalã. Intraoperator se deceleazã o formaåiune tumoralã appendectomy “en bloc” with two enteral loop resection of the
apendicularã invadantã în douã anse enterale. Se practicã permeated ileum followed by two T-T enteral anastomosis. The
apendicectomie în bloc cu douã rezecåii segmentare enterale æi pathologic examination revealed appendiceal mucinous
restabilirea continuitãåii digestive prin douã anastomoze cystadenoma. Postoperative course was favorable, the patient
entero-enterale T-T. Examenul anatomopatologic pune being discharged on the seventh postoperative day.
diagnosticul de chistadenom mucinos apendicular. Evoluåia Postoperative checks performed at 3, 6, 12 and 24 months
postoperatorie este favorabilã, pacienta fiind externatã în ziua (including colonoscopy) have not showed pathological
7 postoperator. Controalele periodice efectuate la 3, 6, 12 æi 24 changes.
de luni (inclusiv colonoscopia) relevã relaåii normale, fãrã
semne de recidivã. Key words: appendix, mucocele, intestinal obstruction,
mucinous cystadenoma
Cuvinte cheie: apendice, mucocel, ocluzie intestinalã,
chistadenom mucinos
Introduction
Corresponding author: Tomuæ Claudiu, M.D., PhD Mucocele is an uncommon pathology of the appendix charac-
Regional Institute of Gastro-Enterology terized by a cystic dilation of the lumen as a result of abnormal
and Hepatology „Octavian Fodor”
Croitorilor Street, no. 19-21, Cluj-Napoca accumulation of mucus. The incidence ranges between 0.2%
Romania, RO-400162 to 0.3% of all appendectomies. It can be asymptomatic, but
E-mail: tomus_claudiu@yahoo.com acute or chronic pain in right iliac fossa is the most frequent
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Case presentation
Discussion
although the most common presentation is acute or cronic
The term “appendiceal mucocele” belongs to a heterogeneous right lower quadrant pain (64%). An abdominal palpable mass
group that includes 4 histopathological findings: simple can be found in 50% of cases, whereas low gastrointestinal
mucocele or retention cyst, mucosal hyperplasia, mucinous bleeding or genitourinary symptoms may be present (1,6,7).
cystadenoma, and mucinous cystadenocarcinoma. (1,4) In our case, the patient came into the emergency room
The first three types are most common, comprising over with signs and symptoms of intestinal obstruction, and the
90% of all cases, while mucinous cystadenocarcinoma is less differential diagnosis at presentation included colonic tumor,
frequent. Mucinous cystadenomas and cystadenocarcinomas of diverticular disease, benign small intestinal stricture secondary
the appendix are often referred to as neoplastic mucoceles of to Crohn’ s disease or tuberculosis. This is a particular aspect
the appendix. (5,6) of this case, because intestinal obstruction complicating an
Appendiceal mucocele is more frequent in individuals appendiceal mucocele has rarely been reported (2,3).
over 50 years of age (4,5) although our patient's age was well Moreover, the mechanism of obstruction is different from
below this limit. those described in literature (compression of ileocecal jonction
Clinical presentation is quite variable. A quarter of patients by mucocele or intussusceptions of the tumor). In our case, the
are asymptomatic and the tumor is discovered incidentally, tumoral mass was permeated into two distinct enteral loop,
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