Yamagishi Yutaka, Kawaguchi Masahiko, Tateno Kei, Hashimoto Masashi, Kimura Karin, Azuma Kotaro, Kato Hideaki, Watanabe Toru
Dept. of Surgery, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations.
Gan To Kagaku Ryoho. 2024 Jun;51(6):663-665.
A 46-year-old female presented persistent right lower abdominal pain for 4 days. Computed tomography revealed an enlarged appendix with a surrounding low-attenuation mass. The patient was diagnosed with appendiceal abscess-forming appendicitis and initially treated with antibiotics. However, owing to the manifestation of nausea as a side effect, laparoscopic appendectomy was performed 3 days after the initial consultation. Intraoperative examination revealed mucinous material on the surface of the appendix and within the abdominal cavity, leading to the decision to perform an appendectomy with partial cecum resection and excision of the omentum with mucinous deposits. Pathological examination confirmed the diagnosis of a perforating low-grade appendiceal mucinous neoplasm and pseudomyxoma peritonei. The patient was subsequently referred to a specialized center for ongoing management, and at 9 months postoperatively, surveillance is being conducted. Low-grade appendiceal mucinous neoplasms can progress to pseudomyxoma peritonei through perforation; however, an optimal treatment approach has not yet been established. In particular, patients in advanced stages of the disease often require challenging management decisions. This case is reported along with a review of the literature to provide further guidance.
一名46岁女性持续右下腹痛4天。计算机断层扫描显示阑尾肿大，周围有低密度肿块。该患者被诊断为阑尾脓肿形成性阑尾炎，最初接受抗生素治疗。然而，由于出现恶心的副作用，在初次就诊3天后进行了腹腔镜阑尾切除术。术中检查发现阑尾表面及腹腔内有黏液物质，因此决定行阑尾切除术并部分切除盲肠及切除有黏液沉积的大网膜。病理检查确诊为穿孔性低级别阑尾黏液性肿瘤及腹膜假黏液瘤。患者随后被转至专科中心进行后续治疗，术后9个月正在进行监测。低级别阑尾黏液性肿瘤可通过穿孔进展为腹膜假黏液瘤；然而，尚未确立最佳治疗方法。特别是疾病晚期的患者往往需要做出具有挑战性的治疗决策。现将该病例报告并结合文献复习以提供进一步指导。
