Matsuo Ippei, Yumoto Tetsuya, Tsuji Akari, Tanabe Ryo, Matsumura Toshihisa, Shimabara Mikoto, Akai Masaaki, Takagi Shoji, Naito Hiromichi, Nakao Atsunori
Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences Okayama University Okayama Japan.
Center for Graduate Medical Education Okayama University Hospital Okayama Japan.
Clin Case Rep. 2025 Jan 2;13(1):e70071. doi: 10.1002/ccr3.70071. eCollection 2025 Jan.
Blunt abdominal trauma causing intraperitoneal injury and/or bleeding can be life-threatening, requiring immediate intervention. Diagnosing these cases can be challenging, especially when pre-existing conditions are involved. Low-grade appendiceal mucinous neoplasm (LAMN) is a rare tumor of the appendix that can lead to pseudomyxoma peritonei. Herein, we present a case of ruptured LAMN following blunt abdominal trauma after a high-energy head-on collision, complicating the differentiation from other intraperitoneal injuries. A 42-year-old Japanese female was brought to our hospital following high-energy head-on collision. She presented with stable vital signs, complaining of anterior chest pain and abdominal tenderness without peritoneal irritation. Computed tomography scans indicated multiple fractures in her chest and complex fluid around the Douglas fossa extending to the ileocecal area, with a slightly dilated appendix tip. Despite stable vitals, emergency laparotomy was needed for suspected peritonitis and/or intraperitoneal hemorrhage. Emergency laparotomy revealed yellowish, jelly-like ascites and a ruptured appendiceal tumor. LAMN was suspected, and the appendix was completely resected, with cytoreductive surgery carefully performed. Histopathological examination confirmed the diagnosis of LAMN. Postoperative course was uneventful, and the patient was discharged on Day 13 and referred for further LAMN management. This case report highlights the diagnostic difficulties of LAMN rupture following blunt abdominal trauma, stressing the need to consider rare conditions like LAMN in differential diagnoses of acute abdomen posttrauma.
钝性腹部创伤导致腹腔内损伤和/或出血可能危及生命，需要立即干预。诊断这些病例可能具有挑战性，尤其是涉及既往存在的疾病时。低级别阑尾黏液性肿瘤（LAMN）是一种罕见的阑尾肿瘤，可导致腹膜假黏液瘤。在此，我们报告一例高能正面碰撞后钝性腹部创伤导致LAMN破裂的病例，这使得与其他腹腔内损伤的鉴别变得复杂。一名42岁的日本女性在高能正面碰撞后被送往我院。她生命体征稳定，主诉前胸疼痛和腹部压痛，但无腹膜刺激征。计算机断层扫描显示她胸部多处骨折，Douglas窝周围有复杂积液并延伸至回盲部区域，阑尾尖端略有扩张。尽管生命体征稳定，但由于怀疑有腹膜炎和/或腹腔内出血，仍需要进行急诊剖腹手术。急诊剖腹手术发现淡黄色、果冻样腹水和一个破裂的阑尾肿瘤。怀疑为LAMN，遂将阑尾完整切除，并仔细进行了减瘤手术。组织病理学检查确诊为LAMN。术后病程顺利，患者于第13天出院，并被转诊接受进一步的LAMN治疗。本病例报告强调了钝性腹部创伤后LAMN破裂的诊断困难，强调在创伤后急腹症的鉴别诊断中需要考虑LAMN等罕见情况。
