Mucocoele and mucinous tumours of the appendix: A review of the literature.

INTRODUCTION: Mucocoele of the appendix is rarely encountered but consultant general surgical and trainees must be aware of it as a differential diagnosis, due to the nuances associated with its management. We aimed to provide a comprehensive review of the current literature concerning this rare surgical pathology. METHODS: Search terms "appendi*", "tumour", "malignancy", "mucino*" and "cystadenoma" were used in combination to identify papers from PubMed. Abstracts and full text were manually reviewed to identify suitable papers. RESULTS: Full search results included 311 articles. Review of titles and abstracts led to further full text review of 46 articles. Of these 30 were selected for inclusion based on relevance, adequate sample size and recent publication date. DISCUSSION: Mucocoele of the appendix describes dilatation with associated luminal mucin and can result from benign and malignant processes. It contributes 0.2-0.7% of all appendiceal pathologies. The most common presenting symptoms are abdominal pain and a palpable mass in the right iliac fossa. Computed tomography of the abdomen and pelvis is key in facilitating diagnosis, although CEA and CA19-9 also have a role. The major complication of malignant causes of mucocoele is progression to pseudomyxoma peritonei. Treatment is surgical with or without chemotherapy depending on the underlying cause. Prognosis depends on aetiology. CONCLUSION: Mucocoele of the appendix is a rare diagnosis. However, given the possibility of neoplastic peritoneal dissemination, it should be considered as a diagnosis, especially in older females with non-specific symptoms similar to appendicitis.

Constipation: take it seriously.

A case report of a young, healthy female who presented as an emergency with large bowel obstruction secondary to a rectosigmoid tumour. Acute presentation was preceded by a progressive history of change in bowel habit managed medically in the community with laxative treatment. The family history of note included breast cancer of an identical triplet aged 41 years. An emergency Hartman's procedure was successfully performed the same day as presentation due to the high risk of perforation. The patient was discharged home within a week. Histology confirmed adenocarcinoma, Dukes' Stage C and oncologists have now taken over care of the patient. Discussion points explore whether it is appropriate to refer a young healthy patient presenting with a change in bowel habit if she is resistant to medical management in the community and in the absence of other red flag symptoms. The family history of malignancy and genetic associations are also considered.