RÉSUMÉ
Abstract Mucoceles of the appendix are rare and can have quite variable imaging and clinical presentations, sometimes mimicking an adnexal mass. The underlying cause can be neoplastic or non-neoplastic. The typical imaging appearance of a mucocele of the appendix is that of a cystic structure with a tubular morphology. This structure is defined by having a blind-ending and being contiguous with the cecum. Radiologists should be familiar with key anatomical landmarks and with the various imaging features of mucoceles of the appendix, in order to provide a meaningful differential diagnosis of a lesion in the right lower abdominal quadrant. In addition, a neoplastic mucocele can rupture, resulting in pseudomyxoma peritonei, which will change the prognosis dramatically. Therefore, prompt diagnostic imaging is crucial.
Resumo Mucoceles do apêndice são raras e podem ter uma apresentação clínica e imagiológica bastante variável, por vezes mimetizando patologia anexial. As causas subjacentes podem ser neoplásicas ou não neoplásicas. O aspecto de imagem típico de mucoceles do apêndice é o de uma estrutura de natureza cística com morfologia tubular. Esta estrutura deverá terminar "em fundo cego" e ser contígua com o ceco. Os radiologistas devem estar familiarizados com os pontos anatômicos de referência e com as diferentes características imagiológicas de mucoceles do apêndice, de modo a fornecer um adequado diagnóstico diferencial de uma lesão localizada no quadrante abdominal inferior direito. Para além disso, uma mucocele neoplásica pode sofrer ruptura, resultando em pseudomixoma peritoneal, o que altera drasticamente o prognóstico. Assim, o diagnóstico por imagem em tempo útil é crucial.
RÉSUMÉ
RESUMEN Fundamento: los tumores mucinosos representan alrededor del 8 % de las neoplasias apendiculares y originan dilatación quística del apéndice debido a la acumulación de material gelatinoso. El cistoadenoma mucinoso del apéndice es una rara enfermedad, que cursa de manera asintomática y se diagnostica de manera incidental mediante estudios imagenológicos o intra operatorio y representa de un 0,2 % a 0,6 % de las apendicectomías. Objetivo: presentar el caso inusual de una joven operada por apendicitis aguda que tenía además un cistoadenoma mucinoso del apéndice. Caso clínico: paciente nuligesta, de 19 años de edad con antecedentes de pérdida de peso en un período de seis meses y cuadros recurrentes de dolor en epigastrio que aliviaban con analgésicos, acudió por dolor en el cuadrante inferior derecho del abdomen de 48 horas de evolución, acompañado de náuseas y pérdida del apetito. Al examen físico se constató taquicardia y dolor abdominal a la palpación en la fosa iliaca derecha, con maniobra de Blumberg positiva, el tacto vaginal y rectal resultaron dolorosos. En el acto quirúrgico se constató apéndice cecal engrosado en el tercio proximal, turgente, con una tumoración dura en tercio distal y se realizó apendicectomía sin complicaciones. La evolución fue favorable y fue dada de alta. Conclusiones: a pesar de lo raro de esta afección, el cirujano debe conocer que en un cuadro apendicular puede estar presente este tipo de tumor aún en pacientes jóvenes a fin de tomar la conducta quirúrgica adecuada y evitar complicaciones al enfermo.
ABSTRACT Background: mucinous tumors represent about 8% of appendix neoplasms and cause cystic dilatation of the appendix due to the accumulation of gelatinous material. Mucinous cystadenoma of the appendix is a rare disease, which occurs asymptomatically and is diagnosed incidentally through imaging studies or intra-operatively and accounts for 0.2% to 0.6% of appendectomies. Objective: to present the unusual case of a 19-year-old girl operated on for acute appendicitis who also had a mucinous cystadenoma of the appendix. Clinical case: patient without previous pregnancy, with a history of weight loss in a period of 6 months and recurrent pain in the epigastrium that relieved with analgesics, came for pain in the lower right quadrant of the abdomen of 48 hours of evolution, accompanied by nausea and loss of appetite. Physical examination revealed tachycardia and abdominal pain on palpation in the right iliac fossa, with a positive Blumberg maneuver; vaginal and rectal examinations were painful. In the surgical act, a cecal appendix was found thickened in the proximal third, turgid, with a hard mass in the distal third and an appendectomy was performed without complications. The evolution was favorable and the patient was discharged. Conclusions: despite the rareness of this condition, the surgeon must know that this type of tumor may be present in an appendicular frame even in young patients in order to take the appropriate surgical behavior and avoid complications to the patient.