Secondary torsion of vermiform appendix with mucinous cystadenoma

Abstract

Torsion of the vermiform appendix is a rare disorder, which causes abdominal symptoms indistinguishable from acute appendicitis. We report a case (a 34-year-old male) of secondary torsion of the vermiform appendix with mucinous cystadenoma. This case was characterized by mild inflammatory responses, pentazocine-resistant abdominal pain, and appendiceal tumor, which was not enhanced by the contrast medium on computed tomography presumably because of reduced blood flow by the torsion. These findings may be helpful for the preoperative diagnosis of secondary appendiceal torsion.

Keywords: Appendix; Mucinous cystadenoma; Torsion.

Fig. 1

a-c Enhanced abdominal CT examination showed a cyst originating in the vermiform appendix. The cyst wall was not enhanced by the contrast medium. d The tumor originated in the appendix and was twisted 180° in a clockwise direction (arrow). e The resected tumor was 10 cm in length and 4 cm in diameter. f The specimen contained yellow-colored degenerated mucin. g, h Histological examination. The inner surface was lined by pseudostratified columnar epithelium with slight nuclear atypia. Subepithelial tissue showed dense fibrosis and mild inflammation. Original maginification: g ×20; h ×200. i Enhanced abdominal CT examination in a case of acute appendicitis caused by fecalith. Appendiceal lumen distal to fecalith was dilated and the thickened appendiceal wall was enhanced by the contrast medium (arrow).