A Case of Appendiceal Primary Mucinous Cystadenocarcinoma In Situ Presenting as a Small Bowel Obstruction

Tomoaki Takada^{1) 2)}, Hideaki Yoshida¹⁾, Morio Tsukada¹⁾, Shunich Okushiba²⁾ and Hiroyuki Katoh²⁾

¹⁾Department of Surgery, Yoichi Kyokai Hospital, ²⁾Surgical Oncology, Division of Cancer Medicine, Hokkaido University Graduate School of Medicine

A 94-year-old woman with a distentended abdomen and no histry of previous surgery was found on physical examination to have a distended, tympanic abdomen with tenderness in the right lower abdominal quadrant but without rebound tenderness or muscular guarding. No palpable masses were found. Elevated serum CEA (19.9 ng/ml, normal range:<6.0 ng/ml) was found. Abdominal x-ray showed dilated loops of almost all of the small bowel suggestive of terminal ileum obstruction. Ultrasonograhy (US) showed a cystic mass with variable internal echogenicity and calcification wall in the right lower quadrant. Computed tomography (CT) showed a well-encapsulated cystic mass with cuvilinear calcification wall in the pericecal area compressing the terminal ileum. Small bowel obstruction due to appendiceal mucocele was diagnosed preoperatively. At emergency laparotomy, we found a mass full of mucoid material extending from the appendix, which compressed the terminal ileum, and conducted ileocecal resection. Pathologically we diagnosed appendiceal mucocele caused by mucinous cystadenocarcinoma in situ. The patient had a smooth postoperative course. US and CT were useful in diagnosing mucocele of the appendix and differentiating this from mimicking diseases. We review 66 patients with primary ealy carcionoma, which means the involvement of carcinoma in the mucosal or submucosal layers, of the appendix in the Japanese literature. Our case is the oldest in primary early carcinoma of the appendix, and is the first accompanied by small bowel obstruction.

Key words
early carcinoma of the appendix, appendiceal mucocele, intestinal obstruction

Reprint requests
Tomoaki Takada Department of Surgery, Yoichi Kyokai Hospital 85 Kurokawa-cho, Yoichi-cho, Yoichi-gun Hokkaido, 046-0003 JAPAN

Accepted
January 30, 2002

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