Mechanical intestinal obstruction secondary to appendiceal mucinous cystadenoma: A case report and brief review

Abstract

Background: Appendiceal mucinous cystadenoma can present in various ways, and it is most commonly encountered incidentally during appendectomy, but mechanical intestinal obstruction secondary to an appendiceal mucocele has been rarely reported.

Methods: We report a case of mechanical intestinal obstruction secondary to appendiceal mucinous cystadenoma. After nasogastric decompression and initial aggressive intravenous fluid resuscitation, an emergency operation was performed under the diagnosis of acute mechanical intestinal obstruction.

Results: We performed an appendectomy and intraoperative enteral decompression without anastomoses. The pathologic examination (PE) revealed appendiceal mucinous cystadenoma. After the operation, the patient's recovery went smoothly, and the patient was discharged on the fifth postoperative day. No tumor recurrence was recorded over an 8 month follow-up period.

Conclusion: Early operative intervention should be recommended to the patient with acute mechanical complete intestinal obstruction, especially the patient who had no previous abdominal surgery. And it is vital to discriminate benign and malignantappendiceal mucocel in determining the extent of surgery.

Figure 1

A CT scout of the abdomen revealed dilated small bowel loops with air-fluid levels suggestive of a small bowel obstruction. CT = computed tomography.

Figure 2

This is the appendiceal mucocele, about 4.0 × 2.5 × 2.5 cm.

Figure 3

The mucocele has adhered to the right paracolic sulci like a loop, and the ileum was confined within the loop. The incarcerated ileum was between 2 and 60 cm from a leocecal valve drilled into the loop in a “U” shape. (Appendix is shown by arrow).

Figure 4

A 40 times magnification hematoxylin and eosin (H&E) stained for specimen of the removal appendiceal tumor reveals appendiceal mucinous cystadenoma.