mucocele of the appendix ( collection of mucus within the appendiceal lumen ) is a rare lesion , found in only 0.2% to 0.3% of 43,000 appendectomies reviewed .
currently , the assessment of pelvic masses relies heavily on usg as the primary diagnostic tool .
in such cases , clinical findings and other investigative modalities are warranted to aid the diagnostic process . in spite of extensive preoperative investigations ,
the diagnosis may still remain elusive and may only be made at the time of surgery . some regard this lesion as benign , a result of obstruction of the proximal lumen by fibrosis ; others believe it to be a neoplasm of the appendix .
is the method of choice in the management of simple mucocele and for cystadenoma with an intact base .
several studies ( mostly case reports ) on laparoscopic resection of mucocele have been reported .
a 60-year - old female presented with pain in lower part of abdomen and palpable tender lump in the right ileac fossa .
ultrasound of the abdomen reports a cystic mass of size 12  15 cm with thin internal septations in the right adnexa .
the pneumoperitoneum was created with veress needle using carbon dioxide and the pressure was kept at 11 mmhg .
a 0 telescope was introduced through the umbilical port for the complete examination of the abdomen .
diagnostic laparoscopy revealed approximately 14  15 cm large bluish mucocele of the appendix with omental adhesions .
two 5-mm ports were placed in the supra pubic area below the pubic hair line as the working port .
the mucocele of the appendix was isolated after separating the mesoappendix from it with the help of bipolar cautery . following this ,
mucocele of the appendix [ figure 1 ] was retrieved out in a plastic bag through the umbilical port .
hemostasis was obtained and a suction drain left in situ which was removed when non - productive .
cut section showed appendix was filled with mucin - like material [ figure 2 ] .
she was started orally after 4 hours of operation and solid food on the next day .
appendicular lump from the distal portion of appendix after removal the appendicular lump filled with mucinus material
mucocele of the appendix is a descriptive term for an appendix distended by mucus , secondary to mucinous cystadenoma ( 63% ) , mucosal hyperplasia ( 25% ) , mucinous cystadenocarcinoma ( 11% ) , and retention cyst
. clinical presentation may include right lower quadrant pain , change in bowel habits , per rectal bleeding , or a palpable mass .
approximately 23 - 50% of patients are asymptomatic , with the lesions being discovered incidentally during surgery , radiological evaluations , or endoscopic procedures .
the preoperative clinical diagnosis of appendiceal mucoceles can therefore be difficult because of this lack of clinical symptomotology .
the initial detection of the lesion may be facilitated by radiological , sonographic , or endoscopic means . on barium enema ,
the lesion may be seen as a sharply outlined sub - mucosal or extrinsic mass indenting the cecum and laterally displacing it .
purely cystic lesions with anechoic fluid , hypoechoic masses with fine internal echoes as well as complex hyperechoic masses can be seen depending on the contents .
ct of the abdomen usually shows a cystic well - encapslated mass sometimes with mural calcification , in the expected location of the appendix .
it may be causing extrinsic pressure on the cecal wall without any surrounding inflammatory reaction .
colonoscopic findings include the  volcano sign ,  the appendiceal orifice seen in the center of a firm mound covered by normal mucosa or a yellowish , lipoma - like submucosal mass . in our case , usg was unable to provide a preoperative diagnosis . in our case , the decision for excision of the appendiceal mucocele was made as a result of diagnostic laparoscopy and a need to rule out malignancy .
therefore mucocele of the appendix can mimic an adnexal mass and prove to be a diagnostic challenge . in a woman presenting with right iliac fossa mass and with clinical features not indicative of gynecological pathology , an appendiceal origin should be considered in the differential diagnosis .
surgery is the treatment of choice and should be done early as tumor can not be ruled out as the causative factor for the mucocele .
pre - operative diagnosis is important to avoid unintended rupture and the development of pseudomyxoma peritonei during surgery .
however , laparoscopic dissection , grasping of the appendix specimen , pneumoperitoneum , or transport of the specimen through the abdominal wall might contribute to peritoneal dissemination of a tumor , if present .
these setbacks can be avoided by taking precautions like using bowel holding graspers ( non - traumatic ) to handle the mucocele and using a non - permeable bag to deliver the specimen out of the port .
mucocele of the appendix can mimic an adnexal mass and prove to be a diagnostic challenge .
laparoscopic resection of mucocele of the appendix is feasible in spite of the danger of malignancy , provided necessary precautions are taken .
 mucocele of the appendix is an aseptic dilatation secondary to obstruction . 
 the preoperative clinical diagnosis of appendiceal mucoceles can therefore be difficult because of this lack of clinical symptomotology . 
 surgical excision is the treatment of choice in benign mucocele . 
 we report a case presenting to the surgeons where initial clinical findings and investigations suggested a cyst in the right adnexa . diagnostic laparoscopy revealed mucocele of the appendix and laparoscopic appendicectomy 
 was done . 