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Suggest Treatment For Mucocele Of Appendix
Question: MY grandfather is 70 year old with complain of right lower quadrant pain past 6-7 days was taken to a general medicine specialist who suggested blood test and contrast CT scan. The results just out are follows . moving to a bigger hospital .Slightly elevated WBC & slightly low haemoglobin. No other test done.
contrast CT scan today reports
1. Grossly distended appendix with thickened, edematous & enhancing wall. 42 mm in caliber, wall thickness 9 mm. Marked periappendiceal soft tissue stranding - S/o appendiceal mucocele with acute inflammatory changes.
2. Reactive edematous inflammatory thickening of terminal ileal loop.
3. Multiple diverticular outpouchings are seen involving sigmoid colon and descending colon.
4. Multiple small subcentimeter mesenteric and retroperitoneal lymphnodes are seen.
rest normal
decision time - what kind of operation may sort out the matter and we should be mentally prepared for, would it be a big operation removal of colon type or a minor one like laproscopic type
an immediate reply would be appreciated
regards XXXXXXX XXXXXX
goa
contrast CT scan today reports
1. Grossly distended appendix with thickened, edematous & enhancing wall. 42 mm in caliber, wall thickness 9 mm. Marked periappendiceal soft tissue stranding - S/o appendiceal mucocele with acute inflammatory changes.
2. Reactive edematous inflammatory thickening of terminal ileal loop.
3. Multiple diverticular outpouchings are seen involving sigmoid colon and descending colon.
4. Multiple small subcentimeter mesenteric and retroperitoneal lymphnodes are seen.
rest normal
decision time - what kind of operation may sort out the matter and we should be mentally prepared for, would it be a big operation removal of colon type or a minor one like laproscopic type
an immediate reply would be appreciated
regards XXXXXXX XXXXXX
goa
Brief Answer:
He has to be operated.
Detailed Answer:
Hi,
I understand you wished for a surgical gastroenterologist reply. However since you are looking for an early reply and I have very good experience with such cases I chose to answer the question.
As per your description, your grandfather has mucocele of Appendix. This definitely has to get operated. Now as per world literature, it is better to undergo surgery by open approach rather than Laparoscopy; the reason being mucus in mucocele should not fall into abdominal cavity. Therefore it is preferable to consider open approach is better. Further open approach also allows the surgeon to visualize and palpate pathological structures.
The type of procedure depends upon the intraoperative condition.
- If it is confined only to appendix, Appendicectomy is sufficient.
- If it has involved caecum and ascending colon which is present on right side, then Right colectomy is needed.
The excised specimen of Appendix has to be sent for histopathological examination.
Regarding other findings in CT, small bowel (terminal ileum) will be inflammed to some extent as it is close to appendix. Lymphnodes are enlarged due to infection and inflammation.
Descending colon and sigmoid colon are present on left side. As there is no pain in left lower quadrant, nothing to worry.
Hope I answered your query.
If you have any questions, I will clarify further.
Wish him good health.
Regards
He has to be operated.
Detailed Answer:
Hi,
I understand you wished for a surgical gastroenterologist reply. However since you are looking for an early reply and I have very good experience with such cases I chose to answer the question.
As per your description, your grandfather has mucocele of Appendix. This definitely has to get operated. Now as per world literature, it is better to undergo surgery by open approach rather than Laparoscopy; the reason being mucus in mucocele should not fall into abdominal cavity. Therefore it is preferable to consider open approach is better. Further open approach also allows the surgeon to visualize and palpate pathological structures.
The type of procedure depends upon the intraoperative condition.
- If it is confined only to appendix, Appendicectomy is sufficient.
- If it has involved caecum and ascending colon which is present on right side, then Right colectomy is needed.
The excised specimen of Appendix has to be sent for histopathological examination.
Regarding other findings in CT, small bowel (terminal ileum) will be inflammed to some extent as it is close to appendix. Lymphnodes are enlarged due to infection and inflammation.
Descending colon and sigmoid colon are present on left side. As there is no pain in left lower quadrant, nothing to worry.
Hope I answered your query.
If you have any questions, I will clarify further.
Wish him good health.
Regards
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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