Gupta Prahlad, Mishra Amit Kumar, Deo Anshu, Yadav Radheshyam, K C Milan, Bhattarai Abhishek
Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Int J Surg Case Rep. 2023 Jul;108:108422. doi: 10.1016/j.ijscr.2023.108422. Epub 2023 Jun 17.
Intestinal obstruction due to external compression is a rare condition, and those caused by appendiceal neoplasms like low-grade appendiceal mucinous neoplasms are extremely rare.
A 67-year-old post-menopausal female, with no history of prior abdominal surgery, presented to the emergency room with constipation for 2 days, and peri-umbilical pain and non-projectile bilious vomiting for 19 h. There was mild abdominal distension and diffuse tenderness. After ultrasonography and Computed Tomography (CT) of the abdomen and pelvis, a provisional diagnosis of complete small bowel obstruction secondary to perforated mucinous neoplasm of the appendix was made. An emergency exploratory laparotomy was performed followed by ileo-cecal resection and ileocolic anastomosis. Intraoperative findings revealed bands extending from the appendix to the ileum forming a closed loop with gangrenous spots in the distal ileum and ascitic fluid with mucin. Later, histopathological examination findings were consistent with low-grade appendiceal mucinous neoplasm (LAMN).
We reviewed three cases of intestinal obstruction, caused by compression from a LAMN, including the presented case. Preoperative diagnosis of the cause of small intestinal obstruction on CT is sometimes challenging. Hence, in patients with intestinal obstruction with a transition point in the right lower quadrant of the abdomen on CT, a high index of suspicion for an appendiceal etiology is required.
LAMN with an associated band should be considered as one of the differential diagnoses in the patient presenting with symptoms of complete small intestinal obstruction without prior abdominal surgery.
外部压迫导致的肠梗阻是一种罕见病症，而由阑尾肿瘤如低度阑尾黏液性肿瘤引起的肠梗阻极为罕见。
一名67岁绝经后女性，既往无腹部手术史，因便秘2天、脐周疼痛及非喷射性胆汁呕吐19小时就诊于急诊室。有轻度腹胀和弥漫性压痛。经腹部和盆腔超声及计算机断层扫描（CT）检查后，初步诊断为阑尾黏液性肿瘤穿孔继发完全性小肠梗阻。遂行急诊剖腹探查术，随后进行回盲部切除及回结肠吻合术。术中发现有索带从阑尾延伸至回肠，形成一个闭环，回肠远端有坏疽斑，并有含黏液的腹水。之后，组织病理学检查结果与低度阑尾黏液性肿瘤（LAMN）相符。
我们回顾了3例由LAMN压迫导致肠梗阻的病例，包括本病例。CT术前诊断小肠梗阻的病因有时具有挑战性。因此，对于CT显示腹部右下腹有移行点的肠梗阻患者，需要高度怀疑阑尾病因。
对于无腹部手术史且出现完全性小肠梗阻症状的患者，伴有索带的LAMN应被视为鉴别诊断之一。
