APPENDICOCELE: A CASE REPORT
Joko Pranoto1, Asrul2
1
Surgery Resident, Department of General Surgery, Faculty of Medicine, Universitas Sumatera Utara
2
Department of Surgery, Digestive Division, Faculty of Medicine, Universitas Sumatera Utara
INTRODUCTION
Appendicocele was described for the first time by Rokitansky in
1842.1 Its incidence is 0.2 – 0.4% of all appendectomies
performed, as it is observed predominantly in women with the
ratio of 4:1 versus men and most frequently at the age over 50-
year old.2,3 Appendicocele represents a progressive appendix
dilatation caused by the intraluminal accumulation of a mucous
substance, as it may be a malignant or a benign process.4,5
CASE PRESENTATION
We present a case of a 36-year-old female who presented at
the accident and emergency department of Haji Adam Malik
General Hospital, Medan, Indonesia. She was referred from a
peripheral hospital after having been found to have aching pain
on her right lower quadrant abdomen that has been
progressively becoming worse. Complaints of abdominal pain
have been intensified since 4 days, getting worse over time,
pain is felt throughout the stomach field is not centralized, a
history of previous abdominal pain was encountered .
The patient was otherwise afebrile and hemodynamically
stable. She had normal full blood count, urea and electrolytes,
liver function tests were negative. She was admitted to the ward
on analgesia for having further treatment towards her chief
complaints. The management given to the patient for the first
time is fasting, then IV fluid administration, decompression
using NGT and catheter, then administration of antibiotics. A
stapled functional end-to-end ileocolic anastomosis was
performed. The patient's recovery was uneventful and was
discharged day 6 post-operation. She was seen at the
outpatient clinic 6 weeks later and had an uneventful
postoperative course .
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DISCUSSIONS
The preoperative diagnosis of appendicocele is very important.
Contrast-enhanced CT imaging is the most commonly used
modality for preoperative diagnosis. It informs the choice of
procedure and avoids several possible complications that
appears. Preoperative colonoscopy in this case may reveal a
pathognomonic volcano sign that could possibly describes a
mass obstructing the appendiceal opening with a central crater
that produces mucin.6 Careful consideration should be given to
minimize the rupture of the appendicocele when deciding on
the approach of choice.
Recent evidence suggests that appendectomy-only is curative
for benign, grossly intact mucoceles.7 It is recommended in the
context of these patients be followed-up clinically and by CT
scan for a minimum of 5-10 years postoperatively. Trends of
tumor markers (CEA and CA 19-9) may be used with elevation
suggesting recurrences.8
CONCLUSION
Appendicocele is a rare condition. The clinical presentation is
often non-specific and the clinician should have appendicocele
in mind in patients presenting with long-term right lower
quadrant pain, adnexal masses, and acute appendicitis picture.
Often, the diagnosis is made incidentally during imaging or
surgical procedure. Radiological imaging and careful analysis
are critical as it informs the choice of procedure and
management. Surgical resection is potentially curative and
rupture of the mucocele should be avoided as it may lead to
pseudomyxoma peritonei, a condition with high morbidity and
mortality.
REFERENCES
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1855
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brief review. World J Gastroenterol 2005;11(30):4761-4763
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guidelines, Int. J. Surg. (60) (2018) 132–136.