Intricacies in the surgical management of appendiceal mucinous cystadenoma: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Mucinous cystadenoma is a type of mucocele of the appendix that is rarely encountered in clinical practice. Dogmatic consensus on the optimal surgical modus operandi of appendicular mucocele is lacking in the literature and this remains a subject of controversy. There is little agreement with regard to the best procedure (right hemicolectomy versus appendectomy) or the best surgical approach (laparoscopic versus laparotomy).</p> <p>Case presentation</p> <p>We report the case of a 70-year-old Asian woman from Karachi who presented with pain in the right iliac fossa for 15 days. On physical examination, a mobile and firm mass was palpable in the right iliac fossa. A colonoscopy was performed which showed external compression of the cecum. A biopsy of the mucosa was normal. Computed tomography scan showed a mucocele of the appendix with minimal periappendiceal fat stranding. She underwent an initial diagnostic laparoscopy to evaluate any mucin spillage in the peritoneal cavity. Once no spillage was identified, an open appendectomy was then performed. Intra-operatively, a frozen section of the appendiceal sample was sent to ascertain the need for an extension of surgery to a right hemicolectomy. Absence of any malignancy on the frozen section obviated the need for a surgical extension. The final histopathological examination showed a mucinous cystadenoma of the appendix. The patient was symptom-free at one year after surgery.</p> <p>Conclusion</p> <p>It is important to distinguish between mucinous cystadenomas and mucinous cystadenocarcinomas. However, this distinction remains elusive in the pre-operative setting. A simple appendectomy using an intra-operative frozen section appears to be a reasonable surgical approach for selected cases with an intact mucocele of the appendix. However, long-term follow-up is warranted in such patients to evaluate the risks of using this approach.</p

Ruptured appendiceal cystadenoma presenting as right inguinal hernia in a patient with left colon cancer: A case report and review of literature

BACKGROUND: Mucoceles resulting from cystadenomas of the appendix are uncommon. Although rare, rupture of the mucoceles can occur with or without causing any abdominal complaint. There are several reports associating colonic malignancy with cystadenomas of the appendix. Herein, we report an unusual and interesting case of right inguinal hernia associated with left colon cancer. CASE PRESENTATION: A case of ruptured mucocele resulting from cystadenoma of the appendix was presented as right inguinal hernia in a 70-year-old male. The patient underwent colonoscopy, x-ray, ultrasound and computed tomography. Localized pseudomyxoma peritonei associated with adenocarcinoma of the descending colon was diagnosed. The patient underwent segmental resection of the colon, appendectomy, debridement of pseudomyxoma and closure of the internal ring of right inguinal canal. He is free of symptoms in one year follow-up. CONCLUSION: Synchronous colon cancer may occur in patients with appendiceal mucoceles. In such patients, the colon should be investigated and colonoscopy can be performed meticulously in cases of ruptured mucoceles and localized pseudomyxoma peritonei. Surgical intervention is the current choice of management

Znaczenie aktywności władz gmin dla absorpcji funduszy UE oraz jej wpływ na rozwój lokalny. Przykład gminy Szamocin

The article is aimed at presenting the authorities’ activity when applying for the EU funds and the influence of gained aid on a local development. The Szamocin Commune is the subject of research. The authorities’ activity is the commune’s strength. Despite their mediocre financial situation, approximately 1/4 of their spending is on investments. The commune’s weaknesses include mainly poor quality of the roads in the commune and few sanitary sewage systems. In order to improve the level of a local development and the quality of the inhabitant’s life, investments in these areas have been realized thanks to gained EU funds for several years now. The commune could carry out more EU projects does not have its own sufficient resources required in case of financial engineering. It is one of the two barriers to absorb the EU funds, except for an inefficient system of funds allocation.Celem artykułu jest przedstawienie aktywności władz gminy w ubieganiu się o dofinansowanie unijne oraz wpływ pozyskanego wsparcia z UE na rozwój lokalny na przykładzie gminy Szamocin. W pierwszej części scharakteryzowano gminę w celu zidentyfikowania jej mocnych i słabych stron. Następnie ukazano poziom pozyskanych przez gminę unijnych środków i liczbę realizowanych projektów w różnym czasie; w okresie przedakcesyjnym, 2004-2006 oraz 2007-2013. Wyniki gminy Szamocin zestawiono ze średnią obliczoną dla województwa. W końcowej części opracowania przedstawiono opinie pracowników ds. pozyskiwania środków UE dotyczące barier skutecznej absorpcji. Porównano wyniki badań ankietowych wykonanych w dwóch różnych okresach. Na podstawie badań można stwierdzić, że gmina realizowała unijne projekty zgodnie ze swoimi potrzebami, niwelując słabe strony. Gmina Szamocin mogłaby realizować więcej projektów UE, jednak nie posiada wystarczających środków własnych wymaganych w montażu finansowym. Jest to jedna z dwóch, oprócz nieodpowiedniego systemu rozdziału środków, barier ograniczających absorpcję środków unijnych