Review Article

From Diagnosis to Management; Mucocele of Stump Appendicitis, Extremely Rare Finding in an Uncommon Surgical Disease: Literature Review

Table 2

Investigations, surgical procedure, histopathology, and outcomes.

AuthorInvestigationsSurgical procedureHistopathologyOutcome

Rasch and Strange [8]Barium enema: smooth deformity of the inferomedial border of the cecum with pressure on the terminal ileumExploratory laparotomy and right hemicolectomyCecal wall thickened with connective and muscular tissue
Large amounts of mucous material, occurring in lakes of considerable size
Fibrosis and occasional groups of normal mucus secreting cells
Discharged after 2 weeks

Ozgür et al. [6]CT abdomen (hypoattenuating, 10∗9∗8 cm mass lying in the retrocecal region)
US abdomen 10 × 9 × 8 cm mass with multiple echogenic layers in a wavy pattern filling the entire lesion, with thin but smooth wall
Exploratory laparotomy (9 × 7 × 3 cm mass and a fixed tumor adherent to the abdominal wall, posterior to the cecum
Right hemicolectomy
Firm mass of 9 × 7 × 1.5 cm near the ileocecal region
Normal colonic mucosa papillary projections of the mucinous adenocarcinoma lining the appendiceal mucosa
No follow-up

Cama Jitoko K [21]US scan: normalDiagnostic laparoscopy cystic lesion arising from the base of the stump of appendix
3 × 2 cm, excised laparoscopically
Periappendicitis with chronic inflammation and fibrosisNo follow-up

El Ajmi M, 2009 [10]US scan: hypoechogenic mass 90 × 65 × 55 mm
CT: retroperitoneal cystic structure measuring 13 × 58 cm, without mural calcification
Laparotomy
Retroperitoneal cystic mass right ileocecal resection with sufficient margins
Mucinous cystadenoma of the appendiceal stump
Five lymph nodes examined were free from the tumor
Margins of resection and cytology were negative
Discharge on the 4th postoperative day

Kim et al. [1]Doppler US : a well-defined lobulated mass (10∗6∗30 cm) in the right lower abdomen extending into the right upper thigh
CT : elongated, cystic mass in the extraperitoneal space of the right lower quadrant extending into the right thigh along the right femoral canal, indenting medial aspect and possibly originating from the cecum (i.e., the expected location of the appendix)
Two separate incisions, the cecum, terminal ileum, and a portion of the mass above the right femoral canal were removed with an ileocolostomy
Mass below the right femoral canal was removed separately
Mucinous cystadenomaNo evidence of recurrence 3 years after surgery

Sameera and Sohil [11]Ultrasound: 6 cm cystic lesion around the inferior pole of the right kidney CT
No lesion in kidney but a tubular cystic structure in the right flank with inferior tip at the same site of previously inflamed appendix stump base, mucocele of stump
Exploratory laparotomy and mucocele resectedBenign mucinous cystadenomaThe patient was discharged well

Korkolis et al. [3]CT : elliptical, 7 × 5 cm cystic mass, lying at the inferior aspect of the cecum; the lesion had smooth walls, scattered mural calcifications, and no surrounding inflammationExploratory laparotomy, well-encapsulated and calcified tumor, 8 × 5.5 × 4 cm in size, at the base of originating from the one cm, unburied, appendiceal stump
Limited cecal resection with the mass
Histopathology revealed crowded, villotubular structures, with mild to moderate epithelial atypia together with acellular mucin pooling (75 ml mucin)
No evidence of malignancy
Appendiceal stump mucocele associated with a benign mucinous cystadenoma
Discharged home on the fifth postoperative day
18 months after surgery, free of symptoms
No recurrence

Lien et al. [2]US : dumbbell-shaped, heterogeneous cystic mass with internal echoes, 5 × 5 cm in diameter in the right lower abdomen
CT demonstrated a cystic mass at the inferior aspect of the cecum
Right hemicolectomy; an 8.3 63.5 cm dumbbell-shaped tumor containing yellowish mucus originating from the 1 cm unburied appendiceal stumpMucinous cystadenomaUneventful postoperative course
No recurrence at 2 years

Lien et al. [2]US showed an elongated cystic mass with internal echoes
CT : well-defined cystic lesion without surrounding inflammation adjacent to the cecum and displacing the terminal ileum
The patient refused surgical interventionNoneShe has remained well during the subsequent 4 years

Yeong, [16]CT : intraperitoneal cystic mass in the right upper quadrant with peripheral calcificationLaparotomy
Mass adherent to terminal ileum, cecum, and ascending colon
The right iliac fossa contained scattered grey, mucoid nodules up to 0.4 cm in diameter
Cyst not separated from the colon
Right hemicolectomy
Mucocele due to a papillary cystadenocarcinoma arising in an appendiceal stump and associated with peritoneal metastasesNot mentioned