How Should we Treat Mucinous Appendiceal Neoplasm ? By Laparoscopy or Laparotomy ?: A Case Report

Abstract

Appendicular mucocele (AM) usually denotes a dilatation of the appendiceal lumen as a result of mucus accumulation that may be related to various neoplastic and non-neoplastic processes. Most of them are discovered incidentally. Treatment consists in complete resection avoiding rupture of the cyst in the peritoneal cavity. Indeed, rupture of such a cystic lesion in the peritoneal cavity can induce a catastrophic complication such as ‘pseudomyxoma peritonei’(PMP). Therefore, some authors recommend an open surgical treatment. Currently, the debate concerning the best surgical technique to adopt for AM remains controversial. We report a case of AM found incidentally and treated by laparoscopy. The macroscopic aspect of the appendix suggested the diagnosis intra-operatively and every effort was made to avoid cystic rupture during appendicular resection. The histopathological diagnosis was mucinous cystadeno-ma. The patient is doing well at 2-year follow-up. The reported case and literature review show us that AM is not a contra-indication for laparoscopic surgery, but major concern resides in the early recognition of such a lesion at laparoscopy and in taking appropriate precautionary measures to avoid rupture in the peritoneal cavity.

Key Words:

• Appendicular mucocele
• laparoscopy
• pseudomyxoma peritonei.

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G. Liberale

L. Gabriel Boulevard G. Van Haelen, 20 1190 Bruxelles, Belgique Tel.: [phone] et/ou 0032/477/606766 E-mail: [email protected]