Appendiceal mucocele presenting as acute appendicitis
a Case Report
DOI:
https://doi.org/10.59736/IJP.23.03.974Keywords:
Appendiceal mucocele, Low-grade appendiceal mucinous neoplasm, Pseudomyxoma peritonei, Appendectomy, Mucinous cystadenomaAbstract
Background: Appendiceal mucocele represents cystic expansion of the appendix caused by mucin accumulation, frequently mimicking acute appendicitis clinically.
Case Report: We present a case of elderly male who developed periumbilical discomfort, loss of appetite, and demonstrated positive rebound tenderness on examination. Imaging studies revealed an enlarged, perforated appendix which was initially interpreted as acute appendicitis. Intraoperatively, a significantly distended appendix measuring 4.0 x 2.5 cm containing thick, gelatinous mucoid contents was identified. Histological analysis established the diagnosis of appendiceal mucocele with mucin deposition and clear surgical margins. Postoperative recovery was uneventful. Complete surgical excision remains the primary treatment modality, with minimally invasive techniques being suitable for selected patients, although conventional open surgery was chosen in this instance due to perforation risk.
Conclusion: This case emphasizes the importance of preoperative radiological assessment, good surgical technique to prevent rupture with subsequent pseudomyxoma peritonei, and definitive histopathological diagnosis.
References
Dhage-Ivatury S, Sugarbaker PH. Update on the surgical approach to mucocele of the appendix. J Am Coll Surg. 2006; 202(4):680-4. doi:10.1016/j.jamcollsurg.2005.12.003.
Fransvea P, Puccioni C, Altieri G, et al. Beyond acute appendicitis: a single-institution experience of unexpected pathology findings after 989 consecutive emergency appendectomy. Langenbecks Arch Surg. 2024; 409(1):87. Doi: 10.1007/s00423-024-03277-0.
Giambusso M, Urrico GS, Ciaccio G, Lauria F, D'Errico S. Mucocele of the appendix: case report of a rare disease with changing diagnostic-therapeutic behavior. J Surg Case Rep. 2024; 2024(6):rjae397. doi:10.1093/jscr/rjae397.
Jones MW, Godana I, Hoilat GJ, Deppen JG. Pseudoappendicitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jul 20 [updated 2025 Jan].
Caspi B, Cassif E, Auslender R, Herman A, Hagay Z, Appelman Z. The onion skin sign: a specific sonographic marker of appendiceal mucocele. J Ultrasound Med. 2004; 23(1):117-21; quiz 122-3. doi:10.7863/jum.2004.23.1.117.
Kehagias I, Zygomalas A, Markopoulos G, Papandreou T, Kraniotis P. Diagnosis and treatment of mucinous appendiceal neoplasm presented as acute appendicitis. Case Rep Oncol Med. 2016; 2016:2161952. doi:10.1155/2016/2161952.
Lakemeyer L, Sander S, Wittau M, Henne-Bruns D, Kornmann M, Lemke J. Diagnostic and prognostic value of CEA and CA19-9 in colorectal cancer. Diseases. 2021; 9(1):21. Doi:10.3390/diseases9010021.
Higa E, Rosai J, Pizzimbono CA, Wise L. Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix: a re-evaluation of appendiceal “mucocele.” Cancer.1973;32(6):1525-41.doi:10.1002/1097-0142(197312)32:6<1525
Khandwala K, Sajjad N, Khan DB, Malik AA, Memon WA, Rao MO, et al. CT features with histopathological correlation in inflammatory versus benign and malignant neoplastic appendiceal mucocele: a retrospective cross-sectional study. BMC Gastroenterol. 2025; 25(1):40. Doi: 10.1186/s12876-025-03630-7.
Ma X, Dong W, Yang Q, Yu J, Zhou S, Zhong Y, et al. Unusual giant low-grade appendiceal mucinous neoplasm: a case report and literature review. Medicine (Baltimore). 2025; 104(23):e42828. doi:10.1097/MD.0000000000042828.
Cestino L, Festa F, Cavuoti G, Bonatti L, Soncini S, Dani L, et al. Appendiceal mucocele: three cases with different clinical presentation and review of literature. J Surg Case Rep. 2020; 2020(9):rjaa344. doi:10.1093/jscr/rjaa344.
Singh MP. A general overview of mucocele of appendix. J Family Med Prim Care. 2020; 9(12):5867-71. doi:10.4103/jfmpc.jfmpc_1547_20.
Khan MN, Davie E, Irshad K. The role of white cell count and C-reactive protein in the diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2004; 16(3):17-9.
Wang TT, He JJ, Zhou PH, Chen WW, Chen CW, Liu J. Endoscopic diagnosis and treatment of an appendiceal mucocele: a case report. World J Clin Cases. 2021; 9(16):3936-42. doi:10.12998/wjcc.v9.i16.3936.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Waseem Ullah, Muhammad Daud
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
