Intussusception of a mucocele of the appendix secondary to an obstruction by endometriosis: report of a case

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This case report describes the successful surgical resection of an appendiceal mucocele causing intussusception, identified preoperatively by barium enema and confirmed intraoperatively.

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This paper reports a single case of complete invagination of the cecum caused by a mucocele of the appendix, where endometriosis acted as the obstructing factor. Preoperatively, a barium enema showed a “crab’s claw”-like pattern, and emergency laparotomy identified appendicecal invagination due to the appendicecal mucocele without observing any colonic invagination; the authors performed appendicecal resection. Pathology of the resected specimen demonstrated mucosal hyperplasia with mucin-secreting lesions of the appendix, and the paper reviews theories of appendicecal mucocele pathogenesis while discussing this case’s mechanism. This paper is centrally about endometriosis — it describes appendicecal mucocele intussusception secondary to obstruction by endometriosis.

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Abstract

We treated a patient with a complete invagination of the cecum which contained a mucocele of the appendix secondary to an obstruction by endometriosis. Preoperatively, a barium enema showed a crab's claw-like area without filling in the oral side of the transverse colon. An emergency laparotomy was performed and revealed a mucocele of the appendix to have induced appendicecal invagination; however, no colonic invagination was observed. An appendicecal resection was thus done. Pathologically, the resected specimen was a mucosal hyperplasia with mucin-secreting lesions of the appendix. The theories regarding the pathogenesis of appendicecal mucocele are reviewed and discussed.
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Abstract

We treated a patient with a complete invagination of the cecum which contained a mucocele of the appendix secondary to an obstruction by endometriosis. Preoperatively, a barium enema showed a crab’s claw-like area without filling in the oral side of the transverse colon. An emergency laparotomy was performed and revealed a mucocele of the appendix to have induced appendicecal invagination; however, no colonic invagination was observed. An appendicecal resection was thus done. Pathologically, the resected specimen was a mucosal hyperplasia with mucin-secreting lesions of the appendix. The theories regarding the pathogenesis of appendicecal mucocele are reviewed and discussed. Similar content being viewed by others

References

Collins DC (1963) 71 000 human appendix specimens: a final report summarizing a forty-year study. Am J Proctol 14:365–381 Hapke MR, Bigelow B (1977) Mucocele of the appendix secondary to obstruction by endometriosis. Hum Pathol 8:585–589 Bachman AL, Clemett AR (1971) Roentgen aspects of primary appendicecal intussusception. Radiology 101:531–538 Gilsang V (1977) Displacement of the appendix in intussusception. Am J Roentgenol 142:791–792 Kimura H, Satou T, Takahashi N, Kurachi M, Fujii H, Nakanishi (1995) Intussusception of the cecum with calcified fecaliths. Am J Gastroenterol 90:318–319 Rollenston HD (1898) Intussusception of the appendix. Edinburgh Med J 4:21 Wallner B, Friedrich JM, Oettinger W (1990) Colorectal invagination in adults following removal of a sigmoid polyp. Rontgenblatter 43:78–79 Martin E, Douglas H, Anton T (1981) The ultrasonic appearance of ileocolonic intussusception. J Clin Ultrasound 9:516–518 Weissberg DL, Scheible W, Leopold GR (1977) Ultrasonographic appearance of adult intussusception. Radiology 124:791–792 Kimura H, Yabushita K, Tsuneda A, Tazawa K, Inoue T, Earashi M, Maeda K, Kuroda Y, Tsuji M, Miwa A (1996) Adult colorectal invagination associated with colonic cancer and established by fiberscopy of the sigmoid colon. Endoscopy 28:636 Higa E, Radia J, Pizzimbono CA, Wise L (1973) Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix. Cancer 32:1525–1541 Uohara JK1, Kobara TY (1975) Endometriosis of the appendix. Am J Obstet Gynecol 121:423–426 Author information Authors and Affiliations Rights and permissions About this article Cite this article Kimura, H., Konishi, K., Yabushita, K. et al. Intussusception of a mucocele of the appendix secondary to an obstruction by endometriosis: Report of a case. Surg Today 29, 629–632 (1999). https://doi.org/10.1007/BF02482989 Received: Accepted: Issue date: DOI: https://doi.org/10.1007/BF02482989

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Condition tags

endometriosis

MeSH descriptors

Appendix Cecal Diseases Endometriosis Intussusception Mucocele Adult Appendectomy Cecal Diseases Cecal Diseases Cecal Diseases Endometriosis Female Humans Hyperplasia Intussusception Intussusception Intussusception Mucocele Mucocele Mucocele

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