Appendiceal mucinous cystadenocarcinoma with implantation metastasis to the incision scar and cutaneous fistula.

INTRODUCTION: Mucinous cystadenocarcinoma of the appendix with invasion of the anterior abdominal wall and cutaneous fistula development is a rare condition. To the best of the authors' knowledge, five such cases have been reported in the medical literature. METHODS AND RESULTS: The patient was a 68-year-old man who presented with a mass growing through the incisional scar and a skin fistula with mucinous discharge 1 year after appendectomy via McBurney's incision. Carcinoembroyonic antigen and carbohydrate antigen 19-9 concentration was elevated. Abdominal computed tomography scan revealed a mass in the cecum with involvement of the abdominal wall. Right hemicolectomy with en bloc abdominal wall implant and skin fistula resection with clear margins was performed. DISCUSSION: The patient received intraperitoneal intra- and postoperative chemotherapy. Gross examination of the specimen showed a mass emerging from the remnant stump of the appendix. The patient showed no relapse 1 year after surgery. Clinical, paraclinical features, and treatment options are discussed with review of the literature.

Acute spontaneous chylous peritonitis: report of a case.

Acute abdominal pain with peritonitis due to sudden extravasation of lymph into the peritoneal cavity is a rare condition that is often mistaken for other causes of acute abdomen. The diagnosis of spontaneous chylous peritonitis is rarely suspected preoperatively, usually misdiagnosed with diverse common surgical emergencies. We report the case of an 81 year old female who presented with typical symptoms of acute abdomen, presumed as acute mesenteric ischemia. The diagnosis of chylous peritonitis was established during laparoscopy and treatment consisted of low fat diet and octreotide.