Minimally invasive appendectomy for resection of appendiceal mucocele: Case series and review of the literature

Abstract

Introduction: Appendiceal mucoceles encompass neoplastic and non-neoplastic causes of a distended Appendix filled with mucus. Appendectomy is recommended when an appendiceal mucocele is identified, incidentally or otherwise, in the event it is secondary to a malignancy. For an intact mucocele, it is critically important to avoid rupturing the mucocele during resection, as rupture of a neoplastic mucocele can result in pseudomyxoma peritonei, or mucin deposits in the peritoneum, which is associated with long-term morbidity and mortality. For this reason, laparotomy is the traditionally recommended surgical approach for treatment.

Presentation of cases: In our case series, we describe two patients, a 49-year-old woman and a 79-year-old man, with incidentally identified appendiceal mucoceles. These patients were successfully treated with minimally invasive approaches to appendectomy, one with a robotic approach and one with a hand-assisted laparoscopic approach. The mucoceles were removed without rupture, and both patients recovered well postoperatively without complication.

Discussion: While laparotomy is the traditionally recommended surgical approach for resection of appendiceal mucoceles, certain minimally invasive techniques allow for safe removal of the mucoceles while minimizing the morbidity of laparotomy.

Conclusion: Minimally invasive approaches to appendenctomy, specifically the robotic-assisted approach and the hand-assisted laparoscopic approach, can be considered for safe resection of appendiceal mucoceles.

Keywords: Appendix; Case report; Laparoscopy; Minimally invasive; Mucocele; Robotic surgical procedure; Surgical procedures.

Fig. 1

Computed tomography of the abdomen demonstrating a cystic mass in the right lower quadrant.

Fig. 2

Colonoscopic findings of the appendiceal mass protruding through the appendiceal orifice into the cecum.

Fig. 3

Computed tomography of the abdomen demonstrating a cystic mass in the right lower quadrant.

Fig. 4

Pathologic sectioning of the masses, with mucus noted extruding from the masses. (a) Case 1 and (b) Case 2.