What treatment in appendiceal mucocele?

Introduction: Appendicular mucocele is a rare disease and constitutes 0.2-0.3% of surgically excised appendicitis, more frequently in females (3: 1) and with an average age of 55 (2.4 , 6.12). We distinguish four subtypes characterized with non-specific clinical manifestations. The study proposes, through clinical observation, a focus on the current diagnostic and therapeutic orientation of the pathology. Materials and Methods: From January 2017 to December 2019 consulted the database of the AOU "G Rodolico" University of Catania Department of medical surgical and specialist sciences II 4 patients were treated of which 3 female cases and one sex case male with an average age of 38 (range 41-35) years with appendicular mucocele. the clinical symptomatology was characterized by constipation, asthenia, malaise, rapid weight loss and anemia with abdominal pain arising on average, increasing in localization on the right quadrants with ipsilateral lumbar irradiation. The preoperative diagnosis was difficult. Results: Blood tests were found to be normal, in particular neoplastic markers, with the exception of CEA> 50 in cistoadenocarcinoma. The surgery showed the presence of a voluminous appendicular mucocele with a maximum diameter of 12 cm and a transverse diameter of 8 cm, without evidence of regional lymphadenomegaly or infiltration of neighboring organs; an appendectomy was performed with complete exeresis of the cystic formation. Discussion: The mucocele of the appendix is characterized by the slow accumulation of mucinous material inside its lumen, and includes a heterogeneous group of lesions ranging from the simple accumulation of mucoid material to mucosal hyperplasia, to the cystadenoma up to the cystadenocarcinoma, with an incidence of approximately 0.4% of all cancers of the appendix. ). In the cases described by us, the diagnosis was placed, as often happens, in the suspicion of a subacute appendix. The histological examination showed the presence of a proliferation of epithelial cells with abundant mucin-like material (fig3). The laparoscopic approach is preferred to the laparotomic approach to minimize the risks of bowel rupture and dissemination in the peritoneal cavity of mucus-secreting epithelial cells (1, 11, 12). In the case in which the approach in videolaparoscopy is chosen, the appendix can be enclosed in an endo-bag or in a glove in order to prevent the escape of mucus or the rupture of the neoplasm and of the viscus (2). between the mucocele and a concomitant gastroenteric tumor; the mucosa hyperplasia and the appendicular cystadenoma are in fact considered as the hyperplastic polyp of the large intestine, with the possibility of developing areas of dysplasia with a high degree of malignancy. Conclusion: Although it is a rare disease, the appendicular mucocele must be taken into consideration when facing an appendicular mass, in order to be able to implement during the intervention the precautions aimed at minimizing the risk of dissemination of mucosal epithelial cells in the peritoneal cavity and therefore onset of pseudomixoma peritoneal.