Postoperative Diagnosis of an Unsuspected Ruptured Appendiceal Mucinous Cystadenoma in a Perimenopausal Woman

Background: Appendiceal mucinous neoplasm may be complicated by rupture, leading to peritonitis and pseudomyxoma peritonei. Despite a thorough intraoperative examination, both the presence of appendiceal mucinous neoplasm and its rupture site may be overlooked. In such cases, the correct clinical diagnosis may be challenging. Case: We describe here a 52-year-old woman with a history of chronic pelvic pain and endometriosis, diagnosed initially as a left-sided endometrioma. She was admitted a few days later with worsening pain and fever that persisted despite treatment with antibiotics. Exploratory laparotomy revealed a pelvic abscess of unknown etiology. Appendectomy was performed, although the appendix appeared grossly normal. Pathology was consistent with rupture of an appendiceal mucinous cystadenoma. Conclusions: Although rare, ruptured appendiceal mucinous neoplasm should be considered in patients presenting with an unexplained pelvic abscess. (J GYNECOL SURG 26:219)