Laparoscopic resection of an appendix mucocele in a breast cancer patient
Author(s):
Scarlett Hao, scarlett.hao@som.umaryland.edu; Roberta Lilly, University of Maryland Community Medical group; Hugo Bonatti, University of Maryland Shore Health
Background: Despite growing evidence that acute appendicitis may be treated with antibiotics, the majority of surgeons offer laparoscopic appendectomy (LA) for this disorder. Appendiceal mucocele may be caused by a variety of diseases and surgical removal remains treatment of choice due to the risk of pseudomyxoma peritonei if ruptured. LA has been suggested for this condition. Breast cancer may metastasize to the appendix. In case of hereditary breast cancer, patients may be at increased risk for primary appendiceal cystoadenocarcinoma.
Hypothesis: Laparoscopic appendectomy may be possible in patients with appendix mucocele
Methods: A 45-year-old Caucasian woman with a diagnosis of bilateral invasive lobular breast carcinoma underwent bilateral mastectomy. She was found to have an enlarged appendix consistent with a mucocele on computed tomography scan during staging. Due to potential risk for malignancy and risk for perforation during chemotherapy appendectomy was suggested.
Results: The patient underwent laparoscopic appendectomy using a 5mm port in the left upper and lower quadrant and a 10-12mm umbilical port. A strict minimal touch technique was applied. After creation of a window between mesoappendix and appendix, the vascular pedicle was divided. the appendix was resected with a 1cm rim of the cecal pole using a stapler and the specimen was immediately placed in a retrieval bag and removed from the abdomen. Pathology showed benign cystadenoma. The patient had an uneventful postoperative course and started chemotherapy four weeks later.
Conclusions: Suspicion of appendiceal neoplasm in high risk patients should warrant strong consideration for elective appendectomy. Laparoscopic appendectomy for appendix mucocele can be performed safely without undue increase in risk for spillage if careful technique is undertaken.