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概要

A rare case of mucinous neoplasm in a distal viable remnant appendix four years post-Appendicectomy

Shane Ahern*, Bashir Yasir, Creavin Ben and Ridgway Paul

Abstract:
Appendicectomy is the most commonly performed surgical procedure worldwide. Post-operative complications vary from the common, such as infection, to the sporadic, e.g. stump appendicitis. However, presented here is an exceedingly rare case of mucocele formation developing from a distal segment of appendix left behind after initial appendicectomy, four years prior.  

A 54-year-old female, with a background of previous laparoscopic appendicectomy for simple appendicitis, presented with a three-day history of severe right iliac fossa pain, nausea and anorexia. Computerised tomography (CT) of her abdomen and pelvis revealed a 45 x 80mm cystic enlargement at the base of the appendix. Diagnostic laparoscopy was performed. A large mucocele was observed. It was found to have developed from a still viable remnant distal segment of the previously resected appendix. The mucocele was resected completely without perforation. Histology revealed this lesion to be a low-grade appendiceal mucinous neoplasm (LAMN).
Mucocele formation post-appendicectomy is infrequent but has more commonly been described arising from a remnant appendiceal stump. They tend to occur as a very late post-operative complication, with many discovered greater than ten years after initial resection. Presentation can mimic appendicitis. There appears to be only two previously reported cases of mucocele formation derived from a leftover distal segment of an appendix post-appendicectomy. This is the first case such case containing a LAMN. Appendiceal mucinous neoplasms comprise less than one percent of malignancies and are an uncommon cause of appendicitis. Given their rarity, these cases pose both a diagnostic and therapeutic dilemma.