Hematuria: an unusual presentation for mucocele of the appendix. Case report and review of the literature

Abstract

Mucocele of the appendix is a nonspecific term that is used to describe an appendix abnormally distended with mucus. This may be the result of either neoplastic or non-neopleastic causes and may present like most appendiceal pathology with either mild abdominal pain or life-threatening peritonitis. Urologic manifestations of mucocele of the appendix have rarely been reported. Laparoscopy can be used as a diagnostic tool in equivocal cases. Conversion to laparotomy may be indicated if there is a special concern for the ability to remove the appendix intact or if more extensive resection is warranted, as in malignancy. We here report our experience with a woman presenting with hematuria whose ultimate diagnosis was mucocele of the appendix, and we review the appropriate literature. This case highlights the mucocele as a consideration in the differential diagnosis of appendiceal pathology and serves to remind the surgeon of the importance for careful intact removal of the diseased appendix.

Figure 1.

Intravenous pyelogram showing duplex ureter and multiple opacities outside the free edge of the right kidney.

Figure 2.

CT of abdomen showing soft tissue density in the area of the cecum with associated calcification.

Figure 3.

CT of abdomen at the level of the lower liver showing upper extent of cecal-based mass with calcification.

Figure 4.

Laparoscopic view of grossly dilated appendix being dissected off the cecum; the distal portion was first detached from the liver.

Figure 5.

Microscopic appearance characteristic of mucinous cystadenoma; there is no evidence of deep tissue invasion.