Impending Rupture With a Twisted Huge Appendiceal Mucocele Treated With Totally Laparoscopic Resection: A Case Series

Abstract

Torsion of the appendix is rare, and appendiceal mucocele can be one of its causes. The first case was of a 49-year-old man who visited the emergency room (ER) for abdominal pain. Abdominal computed tomography (CT) showed appendiceal mucocele with suspected torsion and rupture. The patient underwent laparoscopic exploration and appendectomy. The second case was of a 69-year-old man who visited the ER for epigastric pain. Abdominal CT showed suspicious appendiceal mucocele with ischemic change, indicating torsion of the appendix. The twisted appendix was successfully removed by laparoscopic exploration. An appendiceal mucocele is one of the causes of twisted appendix. With torsion, the mucocele can be diagnosed as rupture by ischemia which may lead to pseudomyxoma peritonei. For this reason, open laparotomy has traditionally been preferred. However, an unruptured appendiceal mucocele or impending rupture with torsion of the appendiceal mucocele can be treated with totally laparoscopic surgery.

Keywords: Appendiceal mucocele; Laparoscopic appendectomy; Torsion of appendix.

Fig. 1.

Abdominal computed tomography for case 1. (A) Axial view. A 3.4-cm dilatation of the appendix with suspicious torsion and rupture of the appendiceal mucocele. (B) Coronal view. Suspicious wall defects in the appendix.

Fig. 2.

Laparoscopic exploration of case 1. Impending rupture with a twisted appendix was found.

Fig. 3.

Specimen of an appendix in case 1. Gross length of approximately 10 cm (A) and width of approximately 5 to 6 cm (B).

Fig. 4.

Abdominal computed tomography for case 2. (A) Axial view. A decrease in the enhancement of a long appendix. (B) Coronal view. Suspicious torsion of the appendix.

Fig. 5.

Specimen of an appendix in case 2. Gross length of approximately 11 cm in J shape (A) and width of approximately 3 to 4 cm (B).