Mucocele of the Appendix: Case Report and Review of Literature

Appendiceal mucocele is a rare disease. Sometimes it is discovered accidentally and sometimes it resembles acute appendicitis. Correct diagnosis before surgery is very important for the selection of adequate surgical treatment to avoid intraoperative and postoperative complications. Ultrasonography, and particularly computed tomography, should be used extensively for this purpose. If mucocele is treated incorrectly pseudomyxoma peritonei, which is characterized by malignant process, may develop. We present a case of a 54-year-old man who was admitted to the emergency department with the signs of acute appendicitis. Open surgery was performed. At the time of surgery, a cystic mass of the appendix with dimensions 7 × 4 ×3 cm, with inflamed walls, but without perforation was discovered in the right iliac fossa. No discharge was found in the peritoneal cavity. Diagnosis of mucocele was suspected. Only appendectomy was performed because no pathologic process was found in the base of the appendix and lymph nodes were not increased in size. Hystopathologic diagnosis was mucinous cystadenoma. After 2 years, the patient is feeling well.     

Hematuria: an unusual presentation for mucocele of the appendix. Case report and review of the literature.

Mucocele of the appendix is a nonspecific term that is used to describe an appendix abnormally distended with mucus. This may be the result of either neoplastic or non-neopleastic causes and may present like most appendiceal pathology with either mild abdominal pain or life-threatening peritonitis. Urologic manifestations of mucocele of the appendix have rarely been reported. Laparoscopy can be used as a diagnostic tool in equivocal cases. Conversion to laparotomy may be indicated if there is a special concern for the ability to remove the appendix intact or if more extensive resection is warranted, as in malignancy. We here report our experience with a woman presenting with hematuria whose ultimate diagnosis was mucocele of the appendix, and we review the appropriate literature. This case highlights the mucocele as a consideration in the differential diagnosis of appendiceal pathology and serves to remind the surgeon of the importance for careful intact removal of the diseased appendix.     

经腹腔镜治疗阑尾周围脓肿

经腹腔镜治疗阑尾周围脓肿7例,行阑尾切除术3例,手术时间平均42.3min,行脓肿引流术4例,手术时间平均41.1min,术中引出脓液25～250ml。引流术后二期经腹腔镜阑尾切除术1例,手术时间为39min。无中转开腹,无术后并发症。经腹腔镜治疗阑尾周围脓肿技术可行,具有损伤小、恢复快、疤痕小等优点,较非手术治疗可缩短阑尾周围脓肿的病程,与开腹手术比较减少了切口感染及切口裂开的发生。     

Volvulus of an Appendiceal Mucocele: Report of a Case

Few cases of volvulus of an appendiceal mucocele have been reported. The mechanism of torsion seems to be similar to that suggested for ovarian or appendegeal torsion, where a solid organ or mass fixed onto a narrow stalk is a precondition. We report the case of a young woman who presented with signs and symptoms of acute appendicitis. Computed tomography showed a cystic mass of fluid consistency in the right lower quadrant. An emergency laparoscopy revealed a 720° torsion of a gangrenous mucocele around the proximal part of the appendix. We performed a laparoscopic appendectomy and she recovered uneventfully. The presentation of volvulus of an appendiceal mucocele can mimic other common conditions. Prompt surgical intervention is essential to prevent gangrene and perforation. The combination of a cystic, right lower quadrant mass, and clinical findings suggestive of acute appendicitis should alert the clinician to include volvulus of an appendiceal mucocele in the differential diagnosis.     

经脐单孔腹腔镜阑尾切除术中阑尾根部的处理体会

目的:探讨经脐单孔腹腔镜阑尾切除术中阑尾根部处理方法的合理选择。方法:回顾分析45例经脐单孔腹腔镜阑尾切除患者的临床资料,分析阑尾根部的处理方式、手术时间、阑尾闭合时间、阑尾根部直径等。结果:45例手术均获成功,阑尾根部的处理15例采用单纯夹闭法,7例采用单纯结扎法,20例采用结扎+夹闭法,3例采用缝合法。术后2例发生切口感染,无一例发生术后肠漏、腹腔内出血、肠梗阻、腹腔脓肿等严重并发症。结论:单孔腹腔镜阑尾切除术是安全、可靠的,术中应根据阑尾根部的具体情况选择相应的闭合方法。     

Benign Mucinous Cystadenoma of the Appendix Report of 3 Cases. Review of the Literature

Backgrounds/Aims: Inflammation during the early phase of anastomotic wound healing is an essential cellular response and is suppressed by corticosteroids. The anti-inflammatory effect of corticosteroids is largely responsible for its impairment of wound healing in bowel anastomosis. Beta-D-glucan, a commonly used macrophage activator, has been shown to improve anastomotic wound healing under normal conditions. In the present study, we have investigated the effects of beta-D-glucan on anastomotic wound healing in rats treated with long-term corticosteroid. Methodology: 92 male Sprague-Dawley rats were randomized into four groups. 1: control, 2: control + beta-D-glu-can, 3: steroid, 4: steroid + beta-D-glucan. Methylprednisolone (5mg/kg) was injected IM daily for 14 days in groups 3 and 4. After 14 days, following anaesthesia and laparotomy, colonic anastomosis was performed 3 cm away from the peritoneal reflection of rectum. In groups 2 and 4, 100mg/kg beta-D-glucan was administered orally for 7 days before laparotomy. On postoperative day 3, relaparotomies were performed and bursting pressures, hydroxyproline levels and histopathological specimens were studied.

Results: The mean values of bursting pressures groups were 50.8 (95% CI 46.99-56.50), 58.2 (95% CI 54.49-61.90), 32.0 (95% CI 29.21-34.98), 45.9 (95% CI 43.09-48.80) respectively. The differences of the mean values of the groups between group 1 and 2 and also 3 were significant (p = 0.002, p < 0.001). The mean values of hydroxyproline of the groups were 3.8 (95% CI 3.56-4.06), 4.7 (95% CI 4.50-5.04), 2.9 (95% CI 2.73-3.20), 3.9 (95% CI 3.65-4.22) respectively. The differences of the values of the groups between control (group1) and group 2 and also group 3 were significant (p = 0.001, p < 0.001). In histopathological examination, increased macrophages and fibroblast population were observed in specimens from beta-D-glucan-treated animals.

Conclusion: The results indicate that in rat model, oral administration of beta-D-glucan causes a significant improvement in the healing of anastomotic wound impaired by long-term corticosteroid administration.     

腹腔镜卵巢良性畸胎瘤手术40例体会

目的 :探讨应用腹腔镜行卵巢良性畸胎瘤手术的适应证与方式 ,预防和减少肿瘤破裂的发生。方法 :4 0例卵巢良性畸胎瘤患者行腹腔镜下囊肿剥除术。结果 :4 0例良性畸胎瘤手术均在腹腔镜下完成 ,无1例中转开腹 ,囊肿破裂 8例。平均手术时间 6 0min ,平均出血 80ml ,无术后出血、脏器损伤及化学性腹膜炎或肉芽肿的发生。结论 :应用腹腔镜行卵巢良性畸胎瘤的手术是完全可行的。     

Intestinal schistosomiasis manifesting as colonic intussusception arising from a mucocele of the appendix: Report of a case

We report a case of intestinal schistosomiasis manifesting as colonic intussusception resulting from a mucocele of the appendix, caused by the obstruction of appendiceal outflow by schistosome egg-induced fibrosis. An 81-year-old woman from China presented with a tender right iliac fossa mass and computed tomography (CT) showed intussusception in the ascending colon. Exploratory laparotomy confirmed an appendiceal mass causing intussusception of the cecum into the ascending colon, with the appendix as the lead point, and lymphnode enlargement. We performed a right hemicolectomy for the appendiceal tumor. However, histologic examination revealed schistosoma eggs within the mucosa, submucosa, muscularis propria, and subserosal fat of the appendix, cecum, and ascending colon, and lymph nodes. The absence of dysplasia in the appendiceal mucosa indicated that the mucocele had developed from fibrosis induced by schistosome eggs obstructing the luminal outflow of mucin. Postoperatively, the patient was given praziquantel and recovered well.     

腹腔镜治疗巨大卵巢囊肿19例报告

目的:探讨腹腔镜巨大卵巢囊肿手术的可行性及安全性.方法:回顾分析2008年3月至2010年7月行腹腔镜手术治疗19例直径15～24cm巨大卵巢囊肿患者的临床资料,总结分析其病例选择、手术方式、手术时间、出血量、住院时间、术后并发症等.结果:19例术中冰冻及病理结果均为良性肿瘤,手术均获成功,无一例中转开腹.16例行卵巢...     

Laparoscopic Ovarian Surgery in Children and Adolescents

Methods:A retrospective chart review was conducted on 106 patients (age, <20 years) who underwent laparoscopic surgery at Kangnam Sacred Heart Hospital from 2006 through 2012.Results:The mean patient age was 17.1 years, and the youngest one was 8. Pathologic analyses revealed that 32 (30.2%) patients had dermoid cyst, 30 (28.3%) had simple cyst, and 15 (14.2%) had endometrioma. Conservative procedures, such as cystectomy (48.1%), aspiration (5.7%), fulguration (4.7%), and detorsion (3.8%), were performed in 65.1% of all cases. A subanalysis revealed that the surgical outcomes of children (age, ≤15 years), including operative time, estimated blood loss, postoperative hemoglobin decrease, and postoperative length of hospital stay, were comparable to those of adolescents (age, 16–19 years), despite significant differences in mean height between the 2 groups (156.1 ± 10.71 cm in children vs. 162.1 ± 5.14 cm in adolescents; P < .0001). (The age break between the study groups was set at 15 years, because most girls reach their adult height between the ages of 15 and 16 years.) No intra- or perioperative complications were noted. In a comparison study of surgical outcomes in 433 women (age, 20–50 years) and the 106 young and adolescent girls in our sample (age, <20 years), those in our patients were not inferior.Conclusion:In children and adolescents, laparoscopic surgery can be successfully performed with conventional instruments designed for use in adults.     

腹腔镜治疗卵巢皮样囊肿手术技巧的总结(附108例分析)

目的:总结腹腔镜治疗卵巢皮样囊肿的手术技巧。方法:对108例腹腔镜治疗卵巢皮样囊肿手术处理和取物方法进行分析总结。结果:108例腹腔镜手术治疗卵巢皮样囊肿,其中48例采用直接剥离法,54例行穿刺抽吸法,6例腹腔镜辅助下腹部小切口顺利完成手术。无1例中转开腹及术后化学性腹膜炎发生。结论:不同手术技巧应用于腹腔镜治疗卵巢皮样囊肿,具有安全、手术时间短、出血少、术后恢复快等优点,但需注意术中操作和适应证的选择。     

腹腔镜与开腹手术治疗卵巢子宫内膜异位囊肿的疗效比较

目的比较腹腔镜手术与开腹手术治疗卵巢子宫内膜异位囊肿的效果,探讨腹腔镜手术治疗卵巢子宫内膜异位囊肿的价值。方法回顾性对比分析随访4个月~5年,平均41.3月的92例腹腔镜手术(腹腔镜组)及52例开腹手术(开腹组)的临床资料。结果腹腔镜组手术时间(69±41.8)m in,术后住院(3.5±1.0)d,术中出血量(55±12.0)m l;开腹组手术时间(137±54.3)m in,术后住院时间(8.7±3.5)d,术中出血量(178±105.9)m l,两组比较差异均有显著性(t=-8.402,-11.048,-13.350;P=0.000)。术后复发率腹腔镜组19.6%(18/92),开腹组19.2%(10/52),两组差异无显著性(2χ=0.002,P=0.961)。术后痛经改善率腹腔镜组66.0%(35/53),开腹组52.8%(19/36),两组比较差异无显著性(2χ=1.580,P=0.209)。结论腹腔镜治疗卵巢子宫内膜异位囊肿的效果与开腹手术基本相同,但腹腔镜具有微创手术的优点,可作为治疗卵巢子宫内膜异位囊肿的首选方法。     

腹腔镜卵巢囊肿剔除术中不同止血方式对卵巢女性激素水平的影响

目的探讨采用不同的止血方式行腹腔镜卵巢良性肿瘤剔除术对患者月经及性激素水平的近期影响。方法回顾分析2008年3月-2009年8月行腹腔镜下良性卵巢囊肿剔除术105例资料,按止血方式分为缝合组（镜下缝合止血47例）和电凝组（双极电凝止血,输出功率40-50w,58例）。观察2组手术时间、出血量、术后月经情况。术前、术后1个月、术后3个月、术后6个月抽血测定17B-雌二醇（E,）、促卵泡激素（FSH）、促黄体生成素（LH）水平。结果与电凝组相比,缝合组手术时间长[（65．2±23．7）rainvs．（40．6±20．5）min,t=5．701,P=0．000],出血量多[（105．2±30．3）mlvs．（65．6±25．4）ml,t=7．285,P=0．000]。电凝组和缝合组各有2例和1例出现卵巢功能早衰（x^2=0．000,P=1．000）。2组术后1个月和3个月时,E2、FSH和LH水平差异无显著性（P〉0．05）,但术后6个月,2组相比,电凝组E：水平降低、FSH和LH水平升高更显著[E：缝合组（341．5±43．8）ng／L,电凝组（246．5±52．5）ng／L,t=9．917,P=0．000;FSH缝合组（6．99±2．32）U／L,电凝组（9．05±2．61）U／L,t=-4．249,P=0．000;LH缝合组（11．33±3．11）U／L,电凝组（15．83±3．50）U／L,t=-6．891,P=0．ooo3。结论从术后激素测定的方面比较,腹腔镜下卵巢的缝合止血法和电凝止血法,在术后早期（3个月内）对卵巢功能的损害相近,但在6个月后,缝合止血法较电凝止血法对卵巢功能的损害小。     

Laparoscopic-assisted transumbilical ovarian cystectomy in a neonate.

The occurrence of ovarian cysts in a neonate is common, but the management of the same is contentious. We present a case of a prenatally diagnosed complex ovarian cyst in a neonate, which was successfully treated by a novel laparoscopic technique. The literature was reviewed and the diagnosis, treatment options, and controversies in the management are discussed, highlighting the role of preservation of the ovary via the laparoscopic-assisted transumbilical ovarian cystectomy procedure.     

免气腹腹腔镜与传统腹腔镜手术治疗卵巢肿瘤的比较

目的:探讨免气腹腹腔镜手术治疗妇科肿瘤的应用及其优点和可行性。方法:比较免气腹与气腹法腹腔镜手术分别治疗卵巢良性肿瘤94例与87例的平均手术时间、术中平均出血量、平均肛门排气时间、术中血气分析、术后并发症等指标。结果:两组手术时间、术中出血量、肛门排气时间、术后发热、术后康复差异无统计学意义(P<0.05)。术后并发症发生率差异有统计学意义(P>0.05)。结论:免气腹腹腔镜手术治疗卵巢良性肿瘤可行,更具安全性,术后并发症发生率低,有较好的临床应用价值。     

腹腔镜诊治卵巢囊肿蒂扭转

目的:探讨腹腔镜在诊断和治疗卵巢囊肿蒂扭转方面的应用价值。方法:对1994年1月至2006年2月14例经腹腔镜诊断和治疗的卵巢囊肿蒂扭转患者的临床资料进行回顾性分析。结果:14例中12例(85.7%)临床表现为急性腹痛,8例(57.14%)伴有恶心呕吐;仅6例术前诊断为卵巢囊肿蒂扭转;14例均经腹腔镜确诊并于镜下完成治疗,行患侧附件切除术9例,蒂扭转复位后行卵巢囊肿剥出术5例,平均手术时间114.3m in,平均出血24.3m l,无手术并发症发生;术后病理诊断卵巢成熟囊性畸胎瘤10例,浆液性囊腺瘤3例,卵巢单纯性囊肿1例。结论:腹腔镜对早期诊断卵巢囊肿蒂扭转有重要价值,在诊断的同时治疗卵巢囊肿蒂扭转安全有效。     

Giant mucinous cystadenoma of the appendix

Mucocele of the appendix is a rare entity, characterized by distension of the lumen caused by an accumulation of mucoid substance. We report herein the case of a 73-year-old man with a 3-week history of abdominal pain caused by a large mucinous cystadenoma. The lesion was removed intact, which is the optimal treatment.     

Laparoscopic management of ovarian dermoid cysts: ten years' experience.

OBJECTIVE: To determine the safety and efficacy of laparoscopic management of ovarian dermoid cysts based upon our ten years' experience. METHODS: Charts of 81 patients who underwent laparoscopic removal of dermoid cysts since March 1988 at Stanford University Medical Center or the Center for Special Pelvic Surgery in Atlanta were reviewed retrospectively. RESULTS: Ninety-three dermoid cysts with a mean diameter of 4.5 cm were removed in 81 patients. Operative techniques used were cystectomy for 70 cysts, salpingooophorectomy for 14, and 9 salpingo-oophorectomy with hysterectomy. Fifty-three cysts were treated via enucleation followed by cystectomy or salpingo-oophorectomy and removal through a trocar sleeve. Twenty-two were treated via enucleation and removal within an impermeable sack. Nine were treated via enucleation and removal by posterior colpotomy. Nine were removed via colpotomy following hysterectomy. We had a total of 39 spillages. Spillage rates varied with removal method: 32 (62%) for trocar removal without an endobag, 3 (13.6%) for removal within an endobag, and 4 (40%) with colpotomy removal. No spillage occurred for the nine patients who had a colpotomy done for hysterectomy. Mean hospital stay after surgery was 0.98 days, and there were no intraoperative complications. In one case, there was a postoperative complication of an incisional infection in the umbilicus. CONCLUSION: Including this and 13 other studies, review of the literature reveals a 0.2% incidence of chemical peritonitis following laparoscopic removal of dermoid cysts. Thus, we conclude that laparoscopic management of dermoid cysts is a safe and beneficial method in selected patients when performed by an experienced laparoscopic surgeon.     

微波固化用于腹腔镜卵巢囊肿剥除后卵巢创面的止血

目的 :探讨微波固化在腹腔镜卵巢囊肿剥除后卵巢创面止血的可行性。方法 :1 2例患者于腹腔镜下卵巢囊肿剥除后用微波固化法处理卵巢创面的出血。结果 :1 2例均止血成功 ,无中转手术。术中出血平均少于 1 0ml ,手术时间平均 4 5min ,平均住院 3d ,无并发症发生 ,全部治愈出院。结论 :腹腔镜下卵巢囊肿剥除后 ,卵巢创面出血用微波固化法止血可靠 ,安全 ,并发症少 ,且能保护卵巢功能     

Minimally invasive appendectomy for resection of appendiceal mucocele: Case series and review of the literature

IntroductionAppendiceal mucoceles encompass neoplastic and non-neoplastic causes of a distended Appendix filled with mucus. Appendectomy is recommended when an appendiceal mucocele is identified, incidentally or otherwise, in the event it is secondary to a malignancy. For an intact mucocele, it is critically important to avoid rupturing the mucocele during resection, as rupture of a neoplastic mucocele can result in pseudomyxoma peritonei, or mucin deposits in the peritoneum, which is associated with long-term morbidity and mortality. For this reason, laparotomy is the traditionally recommended surgical approach for treatment.Presentation of casesIn our case series, we describe two patients, a 49-year-old woman and a 79-year-old man, with incidentally identified appendiceal mucoceles. These patients were successfully treated with minimally invasive approaches to appendectomy, one with a robotic approach and one with a hand-assisted laparoscopic approach. The mucoceles were removed without rupture, and both patients recovered well postoperatively without complication.DiscussionWhile laparotomy is the traditionally recommended surgical approach for resection of appendiceal mucoceles, certain minimally invasive techniques allow for safe removal of the mucoceles while minimizing the morbidity of laparotomy.ConclusionMinimally invasive approaches to appendenctomy, specifically the robotic-assisted approach and the hand-assisted laparoscopic approach, can be considered for safe resection of appendiceal mucoceles.