Preoperative hormonal therapy for a patient with appendiceal endometriosis

The optimal management of patients with appendiceal endometriosis has not been determined because of the difficulty of establishing a preoperative diagnosis. There are no reports of preoperative hormone therapy for a patient with appendiceal endometriosis. We report a patient who underwent resection of appendiceal endometriosis after hormone therapy. A 40-year-old woman with history of recurrent pelvic abscesses presented to the emergency department with lower abdominal pain. The recurrent pelvic abscesses were synchronised with her menstrual cycle. CT scan demonstrated a 25 mm contrast-enhanced luminal structure adjacent to the cecum, which was thought to be a mucocele of the appendix. Considering the recurrent symptoms during menstruation, endometriosis was suspected. Treatment with a gonadotropin-releasing hormone agonist was started for appendiceal endometriosis, which alleviated the symptoms. After 3 months, elective laparoscopic appendectomy was performed. Preoperative hormonal therapy is an option for patients with appendiceal endometriosis, especially when there is concern for dense adhesions.

EP.FRI.999 Case report of a Low Grade appendiceal mucinous neoplasm (LAMN) and review of literature

A mucocele refers to an appendix that has dilated due to progressive accumulation of mucus within its lumen. Appendiceal mucocele is a rare cause of an acute abdomen. They represent 0.2-0.7% of all appendix specimens. LAMN account for less than 0.3% of appendicectomy specimens. We present a 38 year old man with an acute RIF’s pain who went on to have CT scan which revealed a mucocele of appendix but did not show any features of perforation or pseudomyxoma peritonei. He had a laparoscopic converted to open appendicectomy. The proximal 2 cm of appendix was oedematous but normal calibre. Histology revealed a low grade appendiceal mucinous neoplasm (LAMN) that was completely excised. The mucocele of the appendix was first described by Rokitansky in 1842. Appendix mucocele may come as a consequence of obstructive or inflammatory processes, cystadenomas or cystadenocarcinomas. Appendiceal mucinous neoplasms commonly presents in the sixth decade of life and our patient was much younger in comparison. Several literatures suggest the value of preoperative CT imaging in obtaining diagnosis and also in planning further treatment. Appendicectomy or a right hemicolectomy is treatment of choice based on presence or absence of following factors 1. Perforated mucocele 2. Involvement of the base of the appendix. 3. Positive lymph nodes of mesoappendix and ileocolic. Patients with malignancy or pseudomyxoma peritonei are likely to require cytoreductive surgery, heated intraoperative intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy.

Mucocele/mucinous cystadenocarcinoma of the appendix

In today’s globalized world, people are significantly affected by the incredibly increased flow of information, obtained mainly from electronic media, crazy speeds, complex high-tech work processes, unhealthy environment, sometimes difficult relationships in society, inflated demands on themselves and others, etc. All this leads to premature depletion of the body’s creative resource, its weakening, development of a variety of diseases, and at an earlier age, including oncopathology. Mucocele of the appendix is a rare pathology with uncharacteristic clinical manifestations, which often resemble acute appendicitis. Surgical intervention should be performed with the maximum prevention of potential dissemination of the contents of the tumor, and its volume depends on the histological form of the pathology. In our patient, the chronic painful process of the appendix sharply “exploded” with the clinical picture of acute appendicitis, which attracted the attention of the patient and physicians. Timely standard appendectomy has now led to the “recovery” of the patient. Otherwise, the course of the disease could end unfavorably. The purpose of our work was to remind everyone of the importance of timely diagnosis of the disease the accuracy of which is confirmed by histopathological examination of the surgical material of the disease-altered organ. The clinical case of mucocele/mucinous cystoadenocarcinoma of the appendix in a female patient V., 51 years old, was analyzed from our practical work, it manifested itself as an acute appendicitis. The results of laboratory and instrumental examination of the patient are presented. However, the real painful changes of the appendix are established postoperatively.

From Diagnosis to Management; Mucocele of Stump Appendicitis, Extremely Rare Finding in an Uncommon Surgical Disease: Literature Review

Mucocele of the appendix is the accumulation of mucoid material in the appendiceal lumen. Although the terminology is imprecise, as it does not differentiate between the benign and malignant nature of the condition, preoperative recognition is imperative as spillage of the mucus during surgical handling can result in grave complications like pseudomyxoma peritonei. Mucocele developing in a stump of the appendix, i.e., a remnant of appendiceal tissue after surgical removal of an inflamed organ, is an extremely uncommon phenomenon, as not many cases are reported in the literature. In this review, all cases reported in English literature are discussed.

PSEUDOMYXOMA ON APPENDICULAR MUCOCELE

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.

Assessment of the Role of Laparoscopic Management in Patients with Complicated Appendicitis

Background: Present research aimed to evaluate the wellbeing and the effectiveness of laparoscopy for managing complicated appendicitis. Subjects and Methods: Present descriptive research was carry out on 50 patients at tertiary care institution of Gujarat for the period of 1 year. This study is including patients of complicated appendicitis undergoing laparoscopic management. Parameters studied included Age, Gender, WBC count, wound infection and hospital stay. Results: There was increase of total leucocytic count (leukocytosis) in most of the patients; Mean WBCs was 12.71 5.37. 33 patients had pus free IPF collection and perforated appendicitis (PA), 11 patients had turbid free IPF collection with AA (highly inflamed appendix), 2 case was mucocele of the appendix, 2 cases of appendicular abscess (3.3%) and 2 cases of gangrenous appendix. Conclusion: management of complicated appendicitis laparoscopically is practicable, secure and can present a small occurrence of infectious impediments, fewer post-operative pain, fast revival and improved cosmesis on the cost of extended operating time than OA.