Torsion of a mucocele of the vermiform appendix: a case report and review of the literature

Abstract

Torsion of a mucocele of the vermiform appendix is an extremely rare condition and also a rare cause of an acute abdomen with a clinical presentation that is indistinguishable from acute appendicitis, and thus, the condition is diagnosed during operation. Here, the authors describe the case of a 78-year-old female, who presented with intermittent abdominal pain. The appendix had a pelvic position and the torsion was counterclockwise. In addition, the torsion was associated with mucocele of the appendix, which was considered a secondary factor of torsion. Appendectomy and drainage were performed.

Keywords: Appendectomy; Mucocele; Torsion abnormality.

Fig. 1

Enhanced abdominal computed tomography (CT) findings. An abdominal CT scan in our 78-year-old female patient with right lower quadrant pain revealed a well-encapsulated cystic mass with intraluminal gas (white arrows) and calcifications (black arrows) in expected region of the appendix.

Fig. 2

Intra-operative view of the torsion of the vermiform appendix. (A) Arrows indicate counterclockwise torsion of the appendix, which was twisted just distal to its base by about 900 degrees (2 and 1/2 turns); (B) Appendix was detorted in a clockwise direction. Arrows indicate mesoappendix behind the appendix, which was twisted by about 180 degrees (1/2 turns).

Fig. 3

Photograph of the pathologic specimen. Grossly, the appendix was approximately 10.5 cm long and 4.7 cm in diameter.

Fig. 4

Photomicrograph of the histopathologic specimen. The lumen of the appendix was dilated and contained large amounts of mucus.