A good surprise of a radiological appendicular mucocele

Abstract

This case report presents a 42-year-old female patient with chronic right lower abdominal quadrant pain, extending to the mid-inguinal region, persisting for two years. Her medical history included right-sided kidney stones and treated atrial fibrillation. Family history included breast cancer on her mother's side. Comprehensive clinical evaluation revealed persistent abdominal pain without physical signs of tenderness or irritation.

Imaging tests initially suggested an appendicular mucocele but lacked definitive confirmation.   Subsequent computed tomography scans and laboratory tests indicated a peritoneal inclusion cyst, presenting diagnostic challenges. After multidisciplinary consultation, surgical excision was recommended. Laparoscopy revealed a peritoneal cyst intimately associated with the ileocecal appendix, leading to their simultaneous removal. Pathological examination confirmed a benign mesenteric cyst.

This case highlights the diagnostic challenges posed by mesenteric cysts and appendiceal mucoceles, which share similar clinical and radiological presentations. Differential diagnosis requires a comprehensive approach involving patient history, physical examination, and imaging. Mesenteric cysts typically necessitate complete surgical excision, while appendiceal mucoceles require appendectomy, considering the potential for malignancy. In this case, initial suspicion of an appendiceal mucocele led to simultaneous resection of the ileocecal appendix and cyst during laparoscopy, with subsequent pathology confirming a benign mesenteric cyst and normal appendix. Early diagnosis and proper management of mesenteric cysts are vital for optimizing patient outcomes and quality of life.