Presentation
Acute abdomen.
Patient Data
A large, dilated, rim-enhancing fluid-filled structure with gas locules and an air-fluid level is present in the right iliac fossa contiguous with the cecum and separate from the ileocecal valve. It has a tubular configuration with a more tubular projection medially from it. There is curvilinear mural calcification within the wall inferiorly.
There is marked surrounding inflammatory fat stranding.No definite free intra-abdominal gas or fluid identified. No diverticular disease.
Gallbladder with a large mixed density gallstone is demonstrated. No pericholecystic fluid or fat stranding to suggest acute cholecystitis.
Fatty pancreatic atrophy (mainly involving the pancreatic head) noted. Tiny renal cysts and contrast in the renal collecting systems noted. Mildly fatty infiltration of the liver.
The remainder of the solid and hollow abdominal viscera are within normal limits for age.
Vaginal ring pessary in-situ projecting into the posterior vaginal fornix.
Minor bibasal atelectasis noted. No destructive bony lesions.
Conclusion: Findings are most in keeping with a large inflamed/super-infected appendiceal mucocele. No definite evidence of perforation. Cholelithiasis.
Case Discussion
Laparotomy and histological evaluation were of an appendiceal mucocoele.
Some relevant aspects about this condition:
- it represents an abnormal accumulation of mucus within the appendix
- it is a result of a chronic appendiceal obstruction that may be caused by either benign or malignant lesions
- main differentials to consider:
- acute appendicitis complicated by an abscess
- inflammatory changes are more exuberant
- thick and irregular abscess wall
- appendiceal tumors: carcinomas or lymphoma
- cecal neoplasms
- acute appendicitis complicated by an abscess
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