Clinicopathological Features and Surgical Management of Appendiceal Mucoceles: A Single-center Retrospective Consecutive Case Series of 15 Patients
Amine Maazouz
Department of Digestive Surgery I, Mohammed V Military Teaching Hospital, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Mehdi Karami *
Department of Digestive Surgery I, Mohammed V Military Teaching Hospital, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Mahmoud Dabbagh
Department of Digestive Surgery I, Mohammed V Military Teaching Hospital, Rabat, Morocco.
Mohamed Ihab Lechhab
Department of Digestive Surgery I, Mohammed V Military Teaching Hospital, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Hind Hablaj
Department of Digestive Surgery I, Mohammed V Military Teaching Hospital, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Mohamed Bouzroud
Department of Digestive Surgery I, Mohammed V Military Teaching Hospital, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Mountassir Moujahid
Department of Digestive Surgery I, Mohammed V Military Teaching Hospital, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Ahmed Bounaim
Department of Digestive Surgery I, Mohammed V Military Teaching Hospital, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Sidi Mohammed Bouchentouf
Department of Digestive Surgery I, Mohammed V Military Teaching Hospital, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Hakim EL Kaoui
Department of Digestive Surgery I, Mohammed V Military Teaching Hospital, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Appendiceal mucocele is an uncommon condition characterised by cystic dilatation of the appendix secondary to intraluminal mucin accumulation. It encompasses non-neoplastic and neoplastic lesions, including low-grade appendiceal mucinous neoplasms (LAMNs) and mucinous adenocarcinomas. Appropriate recognition and careful surgical handling are important because rupture of a mucinous appendiceal neoplasm may result in intraperitoneal mucin dissemination.
Aim: This study describes the clinicopathological features, surgical management and available outcomes of 15 consecutive patients.
Methods: A single-centre retrospective case series included all consecutive patients undergoing surgery between January 2020 and December 2024 with histologically confirmed appendiceal mucocele or mucinous appendiceal lesions. Clinical presentations, imaging findings, operative procedures, histopathology and follow-up were analysed descriptively.
Results: Fifteen patients were included. Mean age was 51.2 years (range, 35–72), and 8 (53.3%) were women. Right lower-quadrant pain occurred in all patients. Ultrasonography suggested the diagnosis in 6/15 (40.0%), whereas computed tomography suggested it in 7/11 examined patients (63.6%). Four patients underwent appendicectomy, two appendicectomy with stapled caecal cuff resection, and nine right hemicolectomy. One laparoscopic procedure was converted to open surgery after intraoperative rupture of a low-grade appendiceal mucinous neoplasm; hyperthermic intraperitoneal chemotherapy was subsequently performed. Histopathology showed nine low-grade appendiceal mucinous neoplasms (60.0%), four simple retention mucoceles (26.7%), and two invasive mucinous adenocarcinomas (13.3%). No 30-day complications, readmissions, or reinterventions occurred, and there was no 30- or 90-day mortality. At a mean follow-up of 19 months, all patients were alive without documented recurrence.
Conclusion: Appendiceal mucoceles require careful handling and individualised surgical management informed by operative findings and histopathology. The short available follow-up limits conclusions about long-term outcomes.
Keywords: Appendiceal mucocele, low-grade appendiceal mucinous neoplasm, mucinous adenocarcinoma, simple retention mucocele, appendicectomy, caecal cuff resection, right hemicolectomy, histopathology, intraoperative rupture