Appendiceal Mucocele

Choi, Young cheol; Jeong, Keuk Won; Lee, Seok; choi, Hyun cheol

Abstract

PURPOSE
Mucocele of the appendix is merely a descriptive term for abnormal mucus accumulation causing distension of the appendiceal lumen, irrespective of the underlying cause. If untreated, one type of mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The purpose of this study is to clarify the clinical pictures of appendiceal mucocele and to provide a guide for treatment.
METHODS
To search the clinical characteristics of appendiceal mucocele, we retrospectively investigated 16 cases of appendiceal mucocele treated from January 1983 to December 1998 at the Department of Surgery, Masan Samsung Hospital.
RESULTS
There were 3 males and 13 females aged 44 to 83 years (mean 59.3 years). The peak incidence was in the 6th decade (6 cases, 37.5%). The most common symptom was right lower quadrant pain, and right lower quadrant tenderness was the most common physical finding. Histopathologic diagnoses were mucosal hyperplasia in 12 cases and mucinous cystadenoma in four. Simple appendectomy was performed in 8 patients with uncomplicated mucosal hyperplasia. Right hemicolectomy was performed in 3 patients with mucinous cystadenoma. Ileocecal resection was performed in one patient with mucosal hyperplasia and in another patient with mucinous cystadenoma. Appendectomy and oophorectomy was performed in 2 patients with mucosal hyperplasia and coexisting ovarian cyst, and appendectomy and fistulectomy, in one patient with mucosal hyperplasia and coexisting appendiceocutaneous fistula. Postoperative complications such as intestinal obstruction and wound infection occurred in 4 cases (25%). There was no postoperative mortality. Thirteen patients remain free of disease after surgical intervention, and one patient died 6 year later of peritoneal seeding caused by advanced gastric cancer.
CONCLUSIONS
Simple appendectomy is a reasonable choice for uncomplicated, unruptured mucoceles; however, a right hemicolectomy or ileocecal resection may be indicated if the mucocele is adherent to, or shows signs of invasion to cecum or ileum. At operation, a careful search should be made for 'coexisting' tumors of the ovary and gastrointestinal tract.