Apendicular cystic dilatation. case report

ABSTRACT Introduction. Mucocele is a dilatation of the vermiform appendix characterized by viscous mucoid material secretion. Its incidence is low -0.2-0.3% to 0.7% of the total of the appendectomies-, therefore, it is considered as a rare entity, which affects mainly women with a ratio of 4:1. Diagnosis is often incidental, and its management is surgical based on histology. Clinical case. 69-year-old male patient who presented with abdominal pain of 5 days of evolution in the right iliac fossa, accompanied by anorexia, nausea and unquantified fever. Physical examination revealed positive Mc Burney's and Blumberg's signs, indicating peritonism. Appendectomy and appendiceal raffia were performed using the Parker-Kerr technique. Intraoperative findings included an appendicular tumor with a thick base and mucoid content. The histo-pathological study showed a cecal appendix structure with coagulative necrosis of the mucosa and the wall, as well as mucosa with focal deposit of mucoid material. The patient was discharged after 8 days without further complications. Conclusion: Studies on appendicular mucocele are scarce, and due to its complications, radiological controls at a shorter time interval, and even early surgical treatment, are necessary to avoid complications such as intestinal obstruction, peritoneal bleeding or pseudomyxoma.

RESUMEN Introducción. El mucocele es una dilatación del apéndice vermiforme que se caracteriza por su contenido mucoide viscoso. La incidencia de esta entidad es baja -entre el 0.2-0.3% y el 0.7% del total de las apendicectomías- por lo que se considera un caso raro, el cual afecta más a mujeres que a hombres, con una relación 4:1. Con frecuencia, el diagnóstico es incidental y su manejo es quirúrgico. Caso clínico. Paciente de 69 años de edad, de sexo masculino, que acude a emergencias debido a un cuadro clínico de dolor abdominal de 5 días de evolución en la fosa iliaca derecha. El dolor se acompaña de anorexia, náuseas y alza térmica no cuantificada. El examen físico revela signos de Mc Burney y Blumberg positivos e irritación peritoneal, por lo que se realiza apendicectomía más rafia de base apendicular. Entre los hallazgos intraoperatorios se observó tumoración apendicular con base ancha y de paredes gruesas, y contenido mucoide. El estudio histopatológico mostró una estructura de apéndice cecal con necrosis coagulativa en mucosa y pared, así como mucosa con depósito focal de material mucoide. El paciente fue dado de alta a los 8 días sin complicaciones. Conclusión: No existen estudios específicos que lleven a predecir el mucocele apendicular, ni estudios que alerten sobre la futura aparición del mismo; no obstante, conocer sus características es útil para sospecharlo en casos con cuadros similares. Debido a sus complicaciones, es necesario considerar controles radiológicos con un menor intervalo de tiempo e, incluso, un tratamiento quirúrgico precoz, con el objetivo de evitar complicaciones tales como obstrucción intestinal, hemorragia o pseudomixoma peritoneal.

Leiomyoma of the Appendix: A Case Report

Leiomyomas of the appendix are rare and most are encountered incidentally during exploration of the abdomen for some other disease, during postmortem examination, or in the course of routine pathologic examinations of surgical specimens. We report here the findings of ultrasonography, CT and surgery of a case of leiomyoma that arose from the appendix; this lesion was pathologically confirmed.

Schwannoma of the Appendix: A Case Report

Schwannoma is a benign neurogenic tumor arising from the nerve sheath, and it presents as a well defined mass. Isolated gastrointestinal schwannoma is a relatively rare finding and schwannoma of the appendix is extremely rare. We report here on a case of schwannoma that arose from the appendix, and this lesion was pathologically confirmed.

Cystic Lymphangioma Arising from the Mesoappendix: A Case Report

Intra-abdominal lymphangiomas are a rare entity. We report a case of cystic lymphangioma arising from the mesoappendix of a 21-year-old female patient. Barium enema examination revealed a pliable submucosal lesion at the cecal base, without contrast filling in the appendiceal lumen. US and CT demonstrated a multiseptated cystic mass in the pericecal and periappendiceal areas.

Complete Invagination of Vermiform Appendix with Adenocarcinoma

Appendiceal intussusception is a very rare pathological condition, an incidence, as revealed by appendectomy specimens, of only 0.01 percent. There are various types among which complete invagination of the appendix is very rare. We encountered a case of intussusception of the appendix with complete invagination induced by appendiceal adenocarcinoma. A preoperative diagnosis of appendiceal adenocarcinoma and intussusception was not possible, but a final pathological report confirmed these conditions and retrospective analysis of a barium enema showed a finger-like filling defect of the cecum, a relatively specific finding in such cases. We describe a case involving a 39-year old man who one month earlier had noted the onset of pain in the right lower abdomen.

Primary Appendiceal Lymphoma Presenting as Acute Appendicitis: A Case Report

Because primary lymphoma of the appendix is a very rare disorder and commonly presented as acute appendicitis,it is seldom diagnosed by preoperative imaging study. We encountered a patient with pathologically proved primaryappendiceal lymphoma associated with acute and chronic appendicitis. Ultrasonogram revealed a non-compressiblesausage-shaped hypoechoic mass with a linear hyperechoic center caused by mucosa-lumen interface in right lowerquadrant. Post-contrast CT examination showed a markedly enlarged target-like appendix with obliteration of thelumen; the outer layer showed higher attenuation than the central portion. There were also multiple strands in theperiappendiceal fat and thickening of adjacent lateroconal fascia and colonic wall, and this suggested acuteappendicitis associated with appendiceal lymphoma.

Malignant Tumors of the Appendix: Imaging Findings

Malignant tumors of the appendix are rare and are histologically similar to those arising elsewhere in theintestines. The frequency of specific tumor types and the clinical presentation of symptomatic tumors are,however, significantly different. Before surgery, correct diagnosis of a malignant appendiceal tumor is rare; mosttumors are diagnosed by a pathologist while examining an appendectomy specimen. With the advent of high resolutionimaging modalities (ultrasound and helical CT), malignant tumors of the appendix may be more accurately diagnosed;this report describes the imaging findings of malignant appendiceal tumors.