Giant mucocele of the appendix in pregnancy: A case report and review of literature

INTRODUCTION: Mucocoele of the appendix is an obstructive dilatation of the appendix by intraluminal accumulation of mucoid material. Mucocoeles may develop by one of four processes: Retention cysts, Mucosal hyperplasia, Cystadenomas, and Cystadenocarcinomas. The clinical presentation of a mucocele is nonspecific and often an incidental finding at operation for acute appendicitis. If mucocoele is allowed to rupture either spontaneously or during surgery, the escape of mucin and epithelial cells into the peritoneal cavity – Pseudomyxoma Peritonei – may occur. PRESENTATION OF CASE: We present the case of a 35 years old pregnant woman, who was admitted to the accident and emergency department with history and ultrasound findings suggestive of acute appendicitis. The ultrasound scan also confirmed a viable fetus at about 23 week’s gestational age. She had an open appendectomy. The intra-operative findings were an enlarged, tense, cystic retro-caecal appendix which was about 14 cm × 5 cm × 3 cm in dimensions. Histopathological examination confirmed mucocoele of the appendix. She had normal vaginal delivery at term and postoperative follow up for 1 year was uneventful. DISCUSSION: Mucocele of the appendix is an uncommon disorder with nonspecific presentation ranging from asymptomatic disease diagnosed incidentally to clinical features of appendicitis. The treatment is surgery. CONCLUSION: Appendiceal mucocoele is difficult to diagnose preoperatively, and a giant size of the simple mucocoele may be connected to hormonal influence of pregnancy. In the index case, as in majority of cases, the definitive diagnosis is made at surgery.