Du, Christine W, MD

Sandhu, Rovinder S, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of SurgeryAppendiceal Mucocele IntussusceptionChristine W. Du MDLehigh Valley Health Network, Christine_W.Du@lvhn.orgRovinder S. Sandhu MDLehigh Valley Health Network, Rovinder_S.Sandhu@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/surgeryPart of the Other Medical Specialties Commons, and the Surgery CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtDu, C. W., & Sandhu, R. S. (2011). Appendiceal Mucocele Intussusception. LVHN Scholarly Works. Retrieved fromhttp://scholarlyworks.lvhn.org/surgery/2Appendiceal Mucocele IntussusceptionChristine Du, MD and Rovinder Sandhu, MD, Lehigh Valley Health Network, Allentown, PennsylvaniaIntroductionAppendiceal mucocele is a rare disease. It can present with numerous clinical  symptoms, such as right lower quadrant  abdominal pain, palpable mass and  gastrointestinal bleeding. It can also be found incidentally in surgical specimens. The incidence has been reported as 0.2-0.4% of all appendiceal specimens. It is histologically divided into four subtypes: mucinous hyperplasia, mucinous cystadeno-carcinomas, mucosal hyperplasia, and  retention cyst.Patients with benign mucocele have a 5-year survival rate of 100% and those with a malignant mucocele have a 5-year survival rate of 45%. Ruptured mucoceles that cause peritoneal contamination regardless whether they are benign or malignant have much poorer outcomes. Unlike the pediatric population where intus-susception without peritonitis treatment can be attempted with reduction, with adult intussusception, there should be no attempt in reduction, only surgical resectionFig. 1-5 : CAT scan of the abdomen and pelvis demonstrating an ileocolic intussusception.Fig. 6: Intraoperative fi nding of an appendiceal mucocele intussusception.Case Report23 year old female has a three week history of right-sided ab-dominal pain presenting to the Emergency Department. She has no signifi cant past medical or surgical history. On presentation, she was hemodynamically stable. Her abdominal exam was soft, but had moderate right lower quadrant tenderness to palpation with no rebound or guarding. CBC, BMP and U/A were all within normal limits. CAT scan of the abdomen and pelvis was obtained and demonstrated an ileocolic intussusception with questionable mucocele within the cecum. (Fig. 1-5)Intraoperative fi nding was an ileocolic intussusception with the appendix as the lead point. (Fig. 6) The intussusception was not reduced. She underwent a laparoscopic-assisted right hemico-lectomy. Her postoperative course was uncomplicated and was discharged on postoperative day 3. Final pathology revealed a 4cm low-grade appendiceal mucinous neoplasm with associated intussusception into the cecum. The proximal ileal and distal  colonic margins were negative for tumor. DiscussionAn appendiceal mucocele presenting as an  intussusception is uncommon. Literature review found no consensus in the long-term follow-up. Appendiceal mucocele is related to tumors and about 11-20% of patients have colonic adeno-carcinoma. Follow-up is required because  recurrences can occur as well as colonic and/or ovarian neoplasms. This includes repeat  imaging, colonoscopy as well as gynecologic pelvic exams. ReferencesGreenfi eld’s Surgery: Scientifi c Principles and Practice. 2010. Karakaya, K et al. Appendiceal mucocele: Case reports and review of current literature. World Journal of Gastroenterology. Apr 2008; 14(14):2280-2283.Palanivelu, C et al. Laparoscopic Right Hemicolectomy for Mucocele Due to a Low-Grade Appendiceal Mucinous Neoplam. Journal of the Society of Laparoendoscopic Surgeons. 2008; 12:194-197.Zagrodnik, D et al. Mucinous Cystadenoma of the Appendix: Diagnosis, Surgical Management and Follow-Up. Current Surgery. 2003 (60)3: 341-343.1 2 3 4 56

Appendiceal Mucocele Intussusception

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Appendiceal Mucocele Intussusception

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