Grabill Nathaniel, Louis Mena, Ray Jonathan W, Tucker Ana, Walker Travelyan, Chambers James
Northeast Georgia Health System, Graduate Medical Education Department, 743 Spring Street NE, Gainesville, GA 30501, United States of America.
Northeast Georgia Health System, Graduate Medical Education Department, 743 Spring Street NE, Gainesville, GA 30501, United States of America.
Int J Surg Case Rep. 2025 Jun;131:111281. doi: 10.1016/j.ijscr.2025.111281. Epub 2025 Apr 8.
Low-grade appendiceal mucinous neoplasms (LAMNs) are rare entities that can present significant challenges when discovered incidentally by general surgeons during surgery or through postoperative pathology. These lesions may mimic common abdominal conditions and are often not suspected preoperatively.
We present a case series of five patients in whom appendiceal mucoceles were incidentally identified either intraoperatively or on postoperative pathological examination. The patients ranged from 36 to 79 years old and presented with symptoms such as right lower quadrant pain, initially attributed to appendicitis, ovarian torsion, or other gynecological conditions. Intraoperative findings varied from dilated appendices with mucinous content to large cystic masses involving adjacent structures.
In each case, the general surgeon had to make immediate decisions regarding management. Surgical interventions included laparoscopic appendectomy and open right hemicolectomy, with an emphasis on careful handling to prevent rupture and spillage of mucin. Postoperative pathology confirmed LAMNs, with tumor stages ranging from pTis to pT4a. Some patients required additional procedures, such as cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), due to the presence of acellular mucin or peritoneal involvement. The discussion focuses on practical guidance for general surgeons when faced with an incidental appendiceal mucocele. Key recommendations include avoiding intraoperative rupture by gentle handling, assessing the need for extended resection based on intraoperative findings, and ensuring thorough communication with pathology for accurate staging. Postoperative management should involve reviewing pathology reports carefully, considering referral to a multidisciplinary team for higher-stage tumors, and implementing long-term surveillance protocols due to the risk of recurrence.
General surgeons play a critical role in the initial management of incidentally discovered appendiceal mucoceles. Prompt recognition and appropriate intraoperative decision-making are essential to optimize patient outcomes. By adhering to careful surgical techniques and collaborating with multidisciplinary teams, surgeons can effectively manage these unexpected findings and mitigate potential complications associated with LAMNs.
低度阑尾黏液性肿瘤（LAMNs）是罕见的病变，当普通外科医生在手术中偶然发现或通过术后病理检查发现时，可能会带来重大挑战。这些病变可能会模仿常见的腹部疾病，术前通常不会被怀疑。
我们报告了一组5例患者的病例系列，这些患者的阑尾黏液囊肿是在术中或术后病理检查时偶然发现的。患者年龄在36岁至79岁之间，表现为右下象限疼痛等症状，最初被归因于阑尾炎、卵巢扭转或其他妇科疾病。术中发现从含有黏液内容物的扩张阑尾到累及相邻结构的大囊性肿块不等。
在每例病例中，普通外科医生都必须就治疗立即做出决定。手术干预包括腹腔镜阑尾切除术和开放性右半结肠切除术，重点是小心操作以防止黏液破裂和溢出。术后病理证实为LAMNs，肿瘤分期从pTis到pT4a。由于存在无细胞黏液或腹膜受累，一些患者需要额外的手术，如减瘤手术联合热灌注化疗（HIPEC）。讨论重点是普通外科医生面对偶然发现的阑尾黏液囊肿时的实用指导。关键建议包括轻柔操作避免术中破裂，根据术中发现评估扩大切除的必要性，并确保与病理科充分沟通以进行准确分期。术后管理应包括仔细审查病理报告，考虑将更高分期的肿瘤患者转诊至多学科团队，并由于复发风险实施长期监测方案。
普通外科医生在偶然发现的阑尾黏液囊肿的初始治疗中起着关键作用。及时识别和适当的术中决策对于优化患者预后至关重要。通过坚持仔细的手术技术并与多学科团队合作，外科医生可以有效管理这些意外发现并减轻与LAMNs相关的潜在并发症。
