Appendiceal intussusception presenting as a caecal mass

@#Introduction: The differential diagnosis of caecal mass is broad and the inclusion of appendiceal pathologies is an important element. Case Report: We report a 37-year-old woman with recurrent right iliac fossa pain. Computed tomography scan revealed a caecal mass suggesting complete inversion or intussusception of the appendix, which was confirmed by pathologic microscopic examination. This case report discusses appendiceal intussusception with emphasis on diagnosis and treatment options. Discussion: Appendiceal intussusception is a rare entity and the complete type typically presents as a polypoid lesion located at the appendiceal orifice in the caecum. It is imperative to include this entity in the differential diagnosis of caecal mass, especially during colonoscopy, as the removal of this polypoid lesion can result in a devastating caecal perforation or haemorrhage.

Appendiceal Intussusception Showing Various Shapes During a Colonoscopy / 대한소화기내시경학회지

Appendiceal intussusception is a rare disease with variable clinical findings, ranging from acute appendicitis to chronic recurrent abdominal pain or rectal bleeding. Occasionally, it is incidentally discovered with no symptoms. Because a preoperative diagnosis is difficult, it can be diagnosed either after surgery, in the case of acute appendicitis, or after a polypectomy, based on being mistaken for a polyp. During a colonoscopy, an appendiceal intussusception should be suspected if the appendiceal orifice is not observed at the cecum and there is a polypoid lesion at the location where the appendiceal orifice is expected. Treatments are usually determined according to preceding diseases. It is important that the colonoscopist avoid careless endoscopic removal by mistaking the intussusception for a polyp.

Adult Intussusception Caused by an Appendiceal Mucocele and Reduced by Colonoscopy

Appendiceal intussusception is a very rare disease that is found in only 0.01% of patients who have undergone an appendectomy. Clinical symptoms vary but include acute appendicitis symptoms such as right lower quadrant abdominal pain or repetitive right lower quadrant crampy pain. Some patients are asymptomatic. Operative treatment is necessary to reduce an appendiceal intussusception in adults, but there is a debate about how to perform the reduction. Successful colonoscopic reductions have been recently reported for some cases. We report a case of appendiceal intussusception that was diagnosed, reduced by colonoscopy, and histologically confirmed as a mucinous cystadenoma after the operation.

A Case of Asymptomatic Appendiceal Intussusception by Mucinous Cystadenoma / 대한소화기내시경학회지

Appendiceal intussusception has rarely been reported, and this has an incidence of 0.01% when performing appendectomy. It develops due to anatomical or pathological conditions such as polyps, worms, carcinomas, mucoceles or fecaliths. Patients with appendiceal intussusception present with various clinical symptoms from no symptoms to acute or chronic lower abdominal pain like that in appendicitis. Yet making the accurate preoperative diagnosis is sometimes difficult. Advanced colonoscopy has recently made it possible to arrive at the preoperative diagnosis and colonoscopy provides the optimal management of appendiceal intussusceptions that show various clinical symptoms. We report here on a 62-year-old woman who has no clinical symptoms of appendiceal intussusception, and the patient was preoperatively diagnosed by colonoscopy and managed with laparoscopic partial cecectomy. The final diagnosis was mucinous cystadenoma-induced appendiceal intussusception.

Laparoscopic Management of Appendiceal Intussusception Caused by Fecaliths

Appendiceal intussusception is a rare condition of abdominal pain. It develops as a result of various anatomic or pathologic conditions, such as polyps, worms, carcinomas, mucoceles, or fecaliths. Furthermore, an accurate preoperative diagnosis of appendiceal intussusception may be difficult. However, recently developed radiologic modalities, such as multidetector CT and laparoscopy, can considerably aid preoperative diagnosis and provide a means of adopting optimal minimally invasive surgery. Here, the authors describe the case of a 30-yr-old woman with the clinical features of acute appendicitis, who was preoperatively diagnosed as having appendiceal intussusception with fecaliths and who was managed by using a laparoscopic partial cecectomy.

Appendiceal Intussusception Resected by Laparoscopy

The appendix has been reported to be a very rare leading point in intussusception with an incidence of 0.01% in surgical and postmortem specimens. In many cases it was developed by secondary conditions, such as polyps, carcinomas, or mucoceles. Some other cases had none of the initiating causes. Therefore, making an accurate diagnosis is important in providing the optimal treatment for the patient. Here, the author presents an appendiceal intussusception case of a 37-year-old male patient whose vermiform appendix had none of the initiating causes. The preoperative diagnosis was an appendiceal mucocele, but an appendiceal intussusception was detected after the operation. The patient was managed with a laparoscopic partial cecectomy and has been followed up.

A case of intussusception by appendiceal mucocele / 대한내과학회지

Intussusception of the appendix is not only extremely rare but also presents with symptoms similar to appendicitis. Therefore, preoperative diagnosis is unusual. On the other hand, appendiceal mucocele refers to obstructive dilatation of the appendiceal lumen caused by mucus. It has been reported in 0.2~0.3% of appendectomy specimens. A 22-year-old woman visited the Emergency Department because of right lower abdominal tenderness with hematochezia. Abdominal CT scan revealed a target sign in the right lower quadrant area that was suggestive of intussusception. The patient underwent emergency surgical reduction of the intussusception and appendectomy. The pathology showed an appendiceal mucocele.

Appendiceal Intussusception Caused by the Mucocele of the Appendix

Mucocele of the appendix is basically a cystic dilatation of the appendix distal to an obstruction of the appendiceal lumen. It develops in unusual situations in which the distal lumen does not contain enough bacteria to initiate appendicitis when obstruction develops. The continuing mucous secretion causes gradual distention of the appendix and thinning of the wall until mucous secretion stops. The changes after the sudden blocking of the lumen of the appendix depend on the amount and character of the content distal to the obstruction. If the lumen is empty, the appendix distends with mucus to form a mucocele. Here we report a case which we experienced a 68-years-old female patient whose vermiform appendix had mucoceles with appendiceal intussusception.

Spontaneously Reduced Invaginated Appendiceal Intussusception after Colonoscopic Examination / 대한소화기내시경학회지

Appendiceal intussusception is an uncommon type of intussusception with the incidence of 0.01% in children and adults. In many cases it was developed by secondary conditions, such as polyps, carcinoma or lymphoma. But some other cases was reduced after barium enema study and had none of initiating causes. Therefore, making an accurate diagnosis is important in providing the optimal treatment for the patient. We present an appendiceal intussusception spontaneously reduced after colonoscpic examination. A 61-year-old woman with indigestion, nausea and right lower quadrant abdominal tenderness was admitted for further evaluation and treatment. Colonoscopic exam revealed a invaginated appendix with normal appearing covring mucosa intraluminaly. Blind mucosal biopsies on the appendiceal orifice yielded mild inflammatory cell infiltration. Two days after the colonoscopic procedure, patient's abdominal symptoms and sign were disappeared. Abdominal CT scan revealed that appendiceal intussusception was spontaneously reduced and a few several reactive mesenteric lymphadenopathy was observed. The ultrasound scan revealed the appendiceal wall swelling. The patient was discharged after the relief of abdominal symptom without further treatment.

Appendiceal Intussusception Caused by Mucinous Cystadenocarcinoma

An intussusception was first reported by Barbette in 1674, but an intussusception of the appendix was first reported in London, in 1858. Of all intussusceptions, 5% occur in adults, and of these 90% are as a result of a primary cause. Therefore, treatment is usually based on the primary cause. An intussusception of the appendix can be treated by barium or air reduction, or by an appendectomy, with manual reduction in pediatrics, but these are very uncommon in adult, and can be treated by various methods, according to the underlying cause. A 74 years old woman was preoperatively diagnosed, by radiological examination, to have an intussusception of the appendix. An exploratory laparotomy was performed, and the lesion confirmed as an intussusception caused by an appendix mass, which was cystic and filled with mucin. Therefore, a right hemicolectomy was performed, with the pathological results confirming a mucinous cystadenocarcinoma of the appendix. Here, we report a case of an adult intussusception of the appendix in a 74 years old woman.