From the Research
An appendiceal mucocele does not always require urgent surgery, but it does need prompt surgical intervention once diagnosed, with the most recent and highest quality study suggesting a laparoscopic approach is feasible and safe 1. The timing of surgery depends on the specific characteristics of the mucocele, presence of symptoms, and risk of complications.
- Asymptomatic, incidentally discovered mucoceles can be scheduled for elective surgery within weeks of diagnosis.
- However, if there are signs of complications such as inflammation, obstruction, or suspected rupture (indicated by severe pain, fever, or peritoneal signs), urgent surgical intervention becomes necessary. The standard treatment is surgical removal, typically through appendectomy, with careful handling to prevent rupture which could lead to pseudomyxoma peritonei, a serious complication where mucin spreads throughout the peritoneal cavity.
- The surgical approach may be either open or laparoscopic, though some surgeons prefer open surgery for larger mucoceles to minimize rupture risk.
- Complete removal with negative margins is essential, and in cases of suspected malignancy, a right hemicolectomy might be performed. Preoperative evaluation should include imaging studies like CT or ultrasound to assess the characteristics of the mucocele and plan the appropriate surgical approach, as seen in studies 2, 3. A recent study published in 2015 1 supports the use of a laparoscopic approach for the surgical management of appendiceal mucocele due to mucinous cystadenoma, with no intraoperative spillage of mucin occurring due to inadvertent rupture of tumor, and resection margins uniformly negative for tumor. This approach is also supported by other studies, such as 4 and 5, which highlight the importance of careful handling and complete removal of the mucocele to prevent complications.