The postoperative course of the patient was uneventful and he was discharged on the sixth postoperative day. Histopathological analysis reconfirmed the diagnosis of pseudomyxoma peritonei of low-grade mucinous carcinoma origin. No further actions were taken because no gross tumor was evident in the cecum, the patient was elderly, and the disease had been only slowly progressing since the supposed initial rupture of the appendix 10 years ago. The cecum was inspected and palpated with no recognition of the appendix. All mucinous substance was aspirated and an omen-tectomy was performed. A laparotomy was performed, during which a large amount of mucinous material in the peritoneal cavity ( Figure 4) and a bulky 8–10 kg gelatinous tumor fully infiltrating the omentum ( Figure 5) were found. Peritoneal aspiration was performed and cytology results finalized the diagnosis.
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An abdominal CT scan indicated the presence of disseminated abdominal masses with associated ascites, suggesting the possible diagnosis of pseudomyxoma ( Figure 3). During the present evaluation, the blood results were normal but tumor markers, including CEA, Ca125 and Ca19.9, were considerably increased. Except for mild prostatic hyperplasia, there were no referred comorbidities. As reported by his relatives, he was then treated conservatively by hospitalization and long-term administration of intravenous antibiotics at another institution. His medical history included a case of diagnosed acute appendicitis 10 years ago, most likely complicated by appendiceal rupture and phlegmon formation. The patient was discharged on the fourth post-operative day after an uneventful recovery and remained asymptomatic ever since (3 months) with no further treatment.Īn 84-year-old Caucasian male patient presented with mild abdominal distension and altered bowel habits, reporting onset of the symptoms 5 months ago.
#Burst appendix survival rate free#
Histopathological analysis showed a low-grade mucinous neoplasm (mucinous cystadenoma) of the appendix, but the 25 lymph nodes examined in the specimen were free of neoplastic disease. The appendix base opened into a hemispherical chamber and was distended with mucin ( Figure 2). Histology revealed appendiceal distension (measuring 2.2×2.7 cm) with associated mucus. There were no signs of intra-abdominal fluid or lymphadenopathy. Extreme care was taken to ensure minimal tumor handling for minimizing the risk of tumor seeding. Based on the preoperative findings and the obvious extent of the mass to the cecum, a right hemicolectomy followed by ileo-transverse colon anastomosis was performed. Colonoscopy showed that the cecum was mildly distorted due to the mass in the appendix and to avoid possible rupture, no further manipulation was applied. The CT scan revealed a 2.2-centimeter, well-defined mucocele of the appendix ( Figure 1). Although both entities illustrate the clinical boundaries of the same problem, they have diverse management options.Ī 70-year-old Caucasian female patient, with unremarkable medical history and no previous abdominal symptoms underwent a computed tomography (CT) of the abdomen and pelvis during routine evaluation of new onset hypertension. In the current study, 2 cases representing the clinical “edges” of this challenging disease are described the first is an appendiceal mucocele and the second is a case of pseudomyxoma peritonei. The latter is commonly referred to as “jelly belly” and constitutes approximately 1% of all colorectal cancers in the United States. Proper management of neoplastic mucoceles is essential to prevent rupture and subsequent development of mucinous intraperitoneal dissemination, resulting in a syndrome called pseudomyxoma peritonei. Treatment is directed towards the underlying pathology. Įtiological factors are rarely inflammatory and are most commonly neoplastic.
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Diagnosis is often difficult to establish preoperatively despite thorough evaluation and most patients remain asymptomatic until the lesions are discovered incidentally either intraoperatively or postoperatively by histopathological examination. The disease represents 0.3–0.7% of appendiceal pathology and 8% of all appendiceal tumors and it is more frequent in females and in adolescents older than 50 years of age. Appendiceal mucocele, first described by Rokitansky, is a morphologic entity referring to localized or diffuse dilatation of the appendiceal lumen by abnormal accumulation of mucus.