Appendiceal Mucocele in an Elderly Patient: How Much Surgery?

Appendiceal mucoceles are rare cystic lesions with an incidence of 0.3–0.7% of all appendectomies. They are divided into four subgroups according to their histology. Even though the symptoms may vary – depending on the level of complication – from right lower quadrant pain, signs of intussusception, gastrointestinal bleeding to an acute abdomen with sepsis, most mucoceles are asymptomatic and found incidentally. We present the case of a 70-year-old patient with an incidentally found appendiceal mucocele. He was seen at the hospital for backache. The CT scan showed a vertebral fracture and a 7-cm appendiceal mass. A preoperative colonoscopy displayed several synchronous adenomas in the transverse and left colon with high-grade dysplasia. In order to lower the cancer risk of this patient, we performed a subtotal colectomy. The appendiceal mass showed no histopathological evidence of malignancy and no sign of perforation. The follow-up was therefore limited to 2 months. In this case, appendectomy would have been sufficient to treat the mucocele alone. The synchronous high-grade dysplastic adenomas were detected in the preoperative colonoscopy and determined the therapeutic approach. Generally, in the presence of positive lymph nodes, a right colectomy is the treatment of choice. In the histological presence of mucinous peritoneal carcinomatosis, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is indicated. In conclusion, mucoceles of the appendix are detected with high sensitivity by CT scan. If there is no evidence of synchronous tumor preoperatively and no peritoneal spillage, invasion or positive sentinel lymph nodes during surgery, a mucocele is adequately treated by appendectomy

Unravelling the interaction between tectonic and sedimentary processes during lithospheric thinning in the Alpine Tethys margins

The discovery of exhumed continental mantle and hyper-extended crust in present-day magma-poor rifted margins is at the origin of a paradigm shift within the research field of deep-water rifted margins. It opened new questions about the strain history of rifted margins and the nature and composition of sedimentary, crustal and mantle rocks in rifted margins. Thanks to the benefit of more than one century of work in the Alps and access to world-class outcrops preserving the primary relationships between sediments and crustal and mantle rocks from the fossil Alpine Tethys margins, it is possible to link the subsidence history and syn-rift sedimentary evolution with the strain distribution observed in the crust and mantle rocks exposed in the distal rifted margins. In this paper, we will focus on the transition from early to late rifting that is associated with considerable crustal thinning and a reorganization of the rift system. Crustal thinning is at the origin of a major change in the style of deformation from high-angle to low-angle normal faulting which controls basin-architecture, sedimentary sources and processes and the nature of basement rocks exhumed along the detachment faults in the distal margin. Stratigraphic and isotopic ages indicate that this major change occurred in late Sinemurian time, involving a shift of the syn-rift sedimentation toward the distal domain associated with a major reorganization of the crustal structure with exhumation of lower and middle crust. These changes may be triggered by mantle processes, as indicated by the infiltration of MOR-type magmas in the lithospheric mantle, and the uplift of the Brianconnais domain. Thinning and exhumation of the crust and lithosphere also resulted in the creation of new paleogeographic domains, the Proto Valais and Liguria-Piemonte domains. These basins show a complex, 3D temporal and spatial evolution that might have evolved, at least in the case of the Liguria-Piemonte basin, in the formation of an embryonic oceanic crust. The re-interpretation of the rift evolution and the architecture of the distal rifted margins in the Alps have important implications for the understanding of rifted margins worldwide, but also for the paleogeographic reconstruction of the Alpine domain and its subsequent Alpine compressional overprint