Appendiceal Mucocele

ABSTRACT

PURPOSE: An appendiceal mucocele refers to an abnormal dilatation of the appendiceal lumen by mucus. It is a rare clinical entity with a reported prevalence rate of 0.2~0.3% of all appendectomies. The purpose of our study was to identify the clinical characteristics of and the proper surgical management for appendiceal mucoceles. METHODS: The hospital records of 24 eligible patients were reviewed. We analyzed demographic data, and pathological and clinical data. RESULTS: There was a significant difference in size (P<0.009) between simple mucoceles (mean, 1.95 cm) and cystadenomas (mean, 3.6 cm). While ultrasonography was the most commonly used test to establish the diagnosis (14 patients), computed tomography and colonoscopy also provided fundamental information in 5 and 2 patients, respectively. An appendectomy was performed in most cases (20 cases, 83%). A cecectomy was performed in 3 cases, and an ileocecal resection was performed in only one case. Among the cases requiring a cecectomy, a laparoscopic cecectomy was performed in one case. A synchronous tumor was present in 5 cases. Three patients had gastric cancer, 1 patient had gallbladder cancer, the other one had endometriosis. CONCLUSIONS: Our study shows that appendiceal mucoceles most frequently present as acute appendicitis and that preoperative diagnosis is difficult to make. All mucoceles should probably be removed to eliminate the chance of progression to malignancy. Also of note was the elevated incidence of associated neoplasms, especially gastrointestinal carcinomas. Some recommend surveillance colonoscopy in patients with a diagnosis of an appendiceal mucocele. We had three cases accompanied by gastric malignancy. Therefore, we suggest that surveillance gastrofiberscopy may be indicated.