scholarly journals PSEUDOMYXOMA ON APPENDICULAR MUCOCELE

2020 ◽  
Vol 8 (12) ◽  
pp. 842-846
Author(s):  
Yehouenou Tessi T. Romeo ◽  
◽  
Asaad El Bakkari ◽  
Adeyemi A. Boris ◽  
Khadija Ben El Hosni ◽  
...  

Mucocele of the appendix is a descriptive term for mucinous distension of the appendiceal lumen (vermiform appendix) regardless of the underlying pathology. It refers to the progressive retrograde dilatation of the vermiform appendix with concomitant intraluminal accumulation of the mucoid substance. It is an uncommon pathology that occurs in both sexes. it especially poses the problem of differential diagnosis in particular in women because of the location of clinical symptoms in the right iliac fossa. The incidence is estimated between 0.2 % and 0.4 % of the appendectomied specimens.The estimated incidence is approximately 1/1 000 000/year. The disease onset is usually after the age of 40 years and more frequently affects females.The means of medical imaging are mainly ultrasound and scanner. On CT typical mucocele appears as a cecal-based, rounded and well-defined mass, thin-walled, with fine parietal calcifications CT density is variable, from fluid to tissue. A stercolith is sometimes visible at the base of the appendix. The wall of the mucocele may be thickened, irregular, taking the contrast there may be peri-appendicular inflammation, which may be inflammatory or tumor, without specificity.The treatment of unbroken appendicular mucocele is surgical, preferably by laparotomy than laparoscopy. The appendectomy is performed, without breaking the appendix, with complete resection of the meso-appendix, and sampling for cytology of the peritoneal fluid.

Author(s):  
Badri V. Sigua ◽  
Vyacheslav P. Zemlyanoy ◽  
Elguja L. Lataria ◽  
Alexey A. Kurkov ◽  
Vyacheslav A. Melnikov ◽  
...  

The mucocele of the appendix is the expansion of the appendix with the accumulation of a large amount of mucus. The mechanism and causes of mucocele are not fully understood. According to some authors, such changes in the appendix can occur due to cicatricial narrowing of the lumen of the appendix, compression or blockage of its base. Other authors believe that the mucocele of the appendix is a benign tumor that develops from the remnants of primitive mesenchyme and is sometimes prone to malignancy. Clinical manifestations of mucocele of the appendix are nonspecific. In a number of patients, this disease causes pain in the right abdomen, more often pulling, intermittent. However, the disease is often asymptomatic. In this regard, diagnosis is established only during performing an operation, most often, regarding acute appendicitis. Nevertheless, instrumental diagnostic methods such as ultrasound and computed tomography of the abdominal and pelvic organs make it possible to suspect mucocele. Despite the frequent asymptomatic, non-aggressive course, a number of life-threatening complications can become the outcome of the mucocele of the vermiform appendix. The most formidable complication is the rupture of the appendix with mucus entering free abdominal cavity, followed by the development of peritoneal pseudomyxoma due to implantation of mucus-forming cells. The only option for radical treatment of the mucocele of the appendix is a surgical intervention. A presented clinical case demonstrates the difficulties of diagnosis, as well as the features of surgical treatment of a patient with a mucocele of the appendix.


2018 ◽  
Vol 159 (19) ◽  
pp. 768-772
Author(s):  
Tamás Vass ◽  
Attila Zaránd ◽  
Dániel Horányi ◽  
László Harsányi

Abstract: Diverticulitis of the vermiform appendix is a rare disease with clinical features often similar to conventional acute appendicitis. The importance of appendiceal diverticulosis is the fact that it can lead to an early and a higher incidence of perforation and therefore a higher mortality rate, in contrast to acute appendicitis alone. In this study we present the clinicopathology, diagnosis and therapy of the disease with a review of the literature. A 65-year-old woman presented to the emergency department with a 48-hour history of intermittent pain in the right iliac fossa. Abdominal ultrasound raised the possibility of acute appendicitis but because of the relative asymptomatic state of the patient, the lack of fever and rebound tenderness we started observation. After 2 days with episodic abdominal pain, the patient was taken to the operating theatre for laparoscopic exploration. Intraoperatively, multiple diverticula were noted on the appendix and appendectomy was performed. Histopathological examination revealed diverticulosis and inflammation of the appendiceal wall. Due to the possible complications, the difficult preoperative diagnosis and its frequent association with appendiceal neoplasm, appendiceal diverticulosis requires special attention. For asymptomatic cases, incidentally diagnosed intraoperatively or discovered by radiology prophylactic appendectomy is recommended. Orv Hetil. 2018; 159(19): 768–772.


2012 ◽  
Vol 01 (01) ◽  
pp. 030-035 ◽  
Author(s):  
Arindom Banerjee ◽  
I. Anil Kumar ◽  
Arunabha Tapadar ◽  
M Pranay

Abstract Background : Appendicitis is one of the most common clinical conditions that require emergency surgery. Variations in anatomical location of appendix can result in different clinical presentations. Anatomical and topographical variations of the caecum are also known to occur. Anatomical variations in caecum have been observed along with the appendix in this study. Aims: To study the variations in the size, shape, position and arterial supply of the caecum and appendix in individuals of different sex and age, a thorough knowledge of which will aid surgeons in performing various abdominal operations in adults and children. Material and methods: The study was carried out on 25 adult cadavers over a period of 3 years. The anatomy of caecum and appendix was studied in detail. Results : The normal position of caecum and appendix in adult cadavers was found to be in the right iliac fossa. In all specimens the shape of caecum was adult (ampullary) type and it was supplied normally in all cases from a branch of the superior mesenteric artery. The appendix was found in the retro-caecal position in majority of cases with a complete meso-appendix in four and an additional blood supply via the artery of Sesachalam was found in two cases. Conclusions: Vermiform appendix is characterized by variability of its location and morphology. The ultimate position of the appendix is influenced by the changes in position and shape which the caecum undergoes during development and growth. The present study observed the appendix and caecum to be found in their normal positions in majority of cases. The average length of caecum and appendix was found to be more in males as compared with females. Appendicitis is one of the most common diseases that need emergency surgery. Variations in anatomical position cause different clinical presentations. A thorough knowledge of normal anatomy and variations of the caecum and appendix is very important to the surgeon performing abdominal operations in adults, children and infants as it helps them to make optimal diagnosis of various pathological conditions related to these organs and treat accordingly.


2011 ◽  
Vol 96 (2) ◽  
pp. 117-119 ◽  
Author(s):  
Pascal Jeanmonod ◽  
Jens Sperling ◽  
Roland Seidel ◽  
Sven Richter ◽  
Otto Kollmar ◽  
...  

Abstract A 49-year-old woman presented with acute abdominal pain in the right iliac fossa in our emergency department. Pain was abrupt in onset and severely colicky in nature. Abnormal laboratory values included a C-reactive protein of 75 mg/L and a CA-125 of 70.3 U/mL. White blood cell count was normal. Abdominal computed tomography (CT) scan revealed an inhomogeneous mass of 9.5 × 3.5 × 5.5 cm in diameter close to the appendix vermiformis and the sigmoid colon. Because of the clinical symptoms of an acute abdomen an explorative laparotomy was performed. Intraoperatively a pedunculated tumor beginning at the serosa of the sigmoid colon was found. The appendix was unremarkable. The macroscopic aspect as well as the backtable incision of the tumor was suspicious of an intraperitoneal liposarcoma. Rapid section and histopathologic examination revealed necrotic fat tissue without any malignancy. The patient was discharged from the hospital 7 days after the operation with normal laboratory parameters and without further complication. When epiploic appendagitis is evident as a big tumor mass in addition to clinical symptoms of an acute abdomen and elevated tumor markers, surgical exploration is mandatory.


2020 ◽  
Vol 2020 (11) ◽  
Author(s):  
M E Knol ◽  
E M de Leede ◽  
A van Beurden

Abstract Mucocele of the appendix refers to an appendix that is distended by mucus and transformed in a mucus-filled sac. Appendicular torsion is rare. Primary and secondary forms of appendicular torsion are known. Our patient presented to the emergency department with complaints mimicking acute appendicitis. Imaging with computed tomography and ultrasound showed a cystic lesion most likely originating from the right ovary. The veriform appendix was located close to this lesion and seemed to be distended. During diagnostic laparoscopy, a torsion of the veriform appendix due to a mucocele was found and an appendectomy was performed. Histopathological analysis confirmed the diagnosis. Torsion of the vermiform appendix is most often diagnosed intra-operatively. Pre-operative radiologic imaging is often not useful in the detection of appendicular abnormalities other than acute appendicitis. The treatment consists of detorsion and appendectomy.


2012 ◽  
Vol 97 (3) ◽  
pp. 266-269 ◽  
Author(s):  
Zaza Demetrashvili ◽  
Mamuka Chkhaidze ◽  
Kakhi Khutsishvili ◽  
Gega Topchishvili ◽  
Tamar Javakhishvili ◽  
...  

Abstract Appendiceal mucocele is a rare disease. Sometimes it is discovered accidentally and sometimes it resembles acute appendicitis. Correct diagnosis before surgery is very important for the selection of adequate surgical treatment to avoid intraoperative and postoperative complications. Ultrasonography, and particularly computed tomography, should be used extensively for this purpose. If mucocele is treated incorrectly pseudomyxoma peritonei, which is characterized by malignant process, may develop. We present a case of a 54-year-old man who was admitted to the emergency department with the signs of acute appendicitis. Open surgery was performed. At the time of surgery, a cystic mass of the appendix with dimensions 7 × 4 ×3 cm, with inflamed walls, but without perforation was discovered in the right iliac fossa. No discharge was found in the peritoneal cavity. Diagnosis of mucocele was suspected. Only appendectomy was performed because no pathologic process was found in the base of the appendix and lymph nodes were not increased in size. Hystopathologic diagnosis was mucinous cystadenoma. After 2 years, the patient is feeling well.


2020 ◽  
pp. 110-114
Author(s):  
О. А. Povch ◽  
Е. N. Shepetko ◽  
О. V. Коvalchuk ◽  
R. О. Leleta ◽  
S. О. Rebenkov

Summary. The aim. To analyze the anamnestic data, clinical symptoms, preoperative diagnosis, features of surgical intervention and the results of histological examination in a patient with mucocele of the appendix (MA), complicated by necrosis and perforation of the wall and formation of retroperitoneal space phlegmon (FRS). Material and methods. An analysis of the case of MA, which was complicated by the atypical course and the development of retroperitoneal space phlegmon, which was diagnosed after multispiral computered tomography of the abdominal cavity (MSCT AC). Results. The patient, despite periodic atypical complaints of discomfort in the right iliac region, did not seek medical attention and was not examined. Operated urgently after performing MSCT AC. Intraoperatively, a rupture of the MA was diagnosed with formation of FRS, which significantly complicated the course of the operation and the course of the postoperative period. Appendectomy, drainage of the abdominal cavity and retroperitoneal space were performed. Gradual improvement and recovery. Conclusions: The acute situation resulting from the rupture of the MA, led to a complex operation. Performing MSCT AC at the prehospital stage makes it possible to diagnose the problem and perform the operation in a timely manner, without waiting for serious complications.


2005 ◽  
Vol 8 (1) ◽  
pp. 49 ◽  
Author(s):  
Mersa M. Baryalei ◽  
Theodorus Tirilomis ◽  
Wolfgang Buhre ◽  
Stephan Kazmaier ◽  
Friedrich A. Schoendube ◽  
...  

Background: Myocardial bridging of the left anterior descending (LAD) artery may result in clinical symptoms. Surgery with cardiopulmonary bypass (CPB) is a therapeutic option with considerable risk. We hypothesized that off-pump supraarterial myotomy could be an effective treatment modality. Methods: Between October 1998 and May 2000, 13 patients were referred for surgery. All were symptomatic despite medical therapy. Anteroseptal ischemia had been proven by thallium scintigraphy in all 13 patients, exercise testing was positive in 11. All patients were operated on with an off-pump approach after median sternotomy. Results: Mean patient age was 61 8 years (range, 43-71 years). Coronary artery disease mandating additional bypasses was present in 3 patients. The bypasses were done off pump in 2 patients. Conversion to on-pump surgery was necessary in 3 of 13 patients (23%) because of hemodynamic compromise (1 patient), opening of the right ventricle (1 patient), and injury to the LAD (1 patient). Supraarterial myotomy was performed in all patients. One patient who underwent surgery with CPB developed postoperative anteroseptal myocardial infarction. Postoperative exercise testing was performed in all patients and did not reveal any persistent ischemia. Mortality was 0%. All patients were free from symptoms and had not undergone repeat interventions after an average of 51 7 months of follow-up. Conclusions: Off-pump supraarterial myotomy effectively relieves coronary obstruction but has a certain periprocedural risk as evidenced by 1 myocardial infarction, 1 right ventricular injury, and 1 LAD injury. Long-term freedom from symptoms and from reintervention favor further investigation of this surgical therapy.


2016 ◽  
Vol 1 (4) ◽  
Author(s):  
Achmad R. Permadi ◽  
Hana Ratnawati ◽  
Teresa L. Wargasetia

Liver cancer is the fifth most common cancer in Indonesia. This research is to find out the prevalence and characteristics of liver cancer patients in Immanuel Hospital Bandung within the January 2013 until December 2014 period based on age, gender, clinical symptoms and predilections. This study was a descriptive verificative research with data retrieval of patients medical records that have been diagnosed with liver cancer that were hospitalized in Immanuel Hospital Bandung within January 2013 until December 2014 period. The study showed that the liver cancer patient prevalence in Immanuel Hospital Bandung within the period of January 2013 until December 2014 was 46 people. Characteristics of liver cancer patients in Immanuel Hospital Bandung within January 2013 until December 2014 period showed that the most liver cancer patients were male, compare with female with ratio 4:1, the most common age group of 56-65 years old, the most common clinical symptoms were abdominal pain with or without reffered pain to the right scapular bone and the most common predilection was right lobe of the liver. Key words: liver cancer, patients' characteristics, prevalence 


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammed Nagdi Zaki ◽  
Aafia Mohammed Farooq Gheewale ◽  
Nada Ibrahim ◽  
Ibrahim Abd Elrahman

Abstract Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.


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