84 - Freie Mitteilung
17. Mai 2019, 08:15 - 09:45, Bellavista 5, 6. OG
Ileocolic intussusception caused by a low-grade appendiceal mucinous neoplasm (LAMN)
T. Kastiunig, M. Trujillo-Wehrli, Presenter: T. Kastiunig (St. Gallen)
Low-grade appendiceal mucinous neoplasm (LAMN) are rare tumours of the vermiform appendix with potential progression to pseudomyxoma peritonei (PMP). Only about 30 cases have been described where a cystadenoma or mucocele can cause an ileocolic intussusception.
A 27 – year old woman with abdominal pain in the right lower abdomen and mild nausea was referred by her general practitioner. On clinical examination, right lower abdomen tenderness on palpation was found. The blood values, including CRP, leukocytes, and lactate, were within normal levels. Ultrasound detected a tumour of the appendix, and the CT scan showed a mucocele of the appendix, without any other pathologies (Fig. 1).
We decided to perform a laparoscopy and found the appendix invaginating into the caecal pole (Fig. 2). To avoid perforation, we performed a lower midline laparotomy and an ileocaecal resection. The patient recovered very well. Two months after surgery the patient had no lingering symptoms. The histological examination showed a LAMN (pTis pN0 (0/15) G1 R0) (Fig. 3), therefore no further surgery or follow-ups had to be carried out.
Surgical resection is the treatment of choice for ileocolic intussusception in adults. Rupture of an appendiceal mucocele might change prognosis and therapeutic management. To avoid rupture and dispersion of mucus into the peritoneal cavity, surgeons should not try to reduce the intussuscepted segment manually or coloscopically. The actual evidence shows that patients with pTis (LAMN) do not develop tumor recurrence and are cured without the necessity of a hemicolectomy.