Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666 (Japan)

We report an instance of appendiceal mucinous cystadenoma that was effectively analyzed preoperatively and treated by laparoscopic resection. We could find spring of gushing lava sign on colonoscopy and cystic injury with no knobs at the informative supplement on figured tomography (CT). With practically no harmful elements in preoperative assessments, we performed laparoscopic appendectomy including the cecal wall. We could try not to perform over the top activity for cystadenoma with exact preoperative determination and intraoperative finding and neurotic conclusion during medical procedure. Appendiceal mucocele is an intriguing sickness that is separated into 3 obsessive sorts: hyperplasia, cystadenoma, and cystadenocarcinoma.

Keywords: Spring of gushing lava sign, Laparoscopic medical procedure, Appendiceal mucinous cystadenoma

Appendiceal mucinous cystadenoma is a generally interesting illness; it is one kind of appendiceal mucocele. Appendiceal mucocele can be separated into 3 neurotic sorts: mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma. Breaking an appendiceal cancer for the most part brings about dispersal of these phones, a condition known as pseudomyxoma peritonei. The treatment for appendiceal mucocele is ordinarily careful resection. Careful methodologies for appendiceal mucocele shift from basic appendectomy to right hemicolectomy with lymph hub analyzation relying upon their danger. Notwithstanding, because of the trouble in separating cystadenoma from cystadenocarcinoma before medical procedure, oversurgery is frequently finished for cystadenoma. Accordingly, the careful methodologies for it actually stay questionable. In preoperative assessments, well of lava sign is a particular finding of appendiceal mucocele. Knobs in the blister or dilatation of lymph hubs are supposed to be threatening elements. Here, we report an instance of appendiceal mucinous cystadenoma that was effectively analyzed before a medical procedure and treated by laparoscopic resection. Perceiving fountain of liquid magma sign and the shortfall of harmful variables preoperatively, in addition to intraoperative obsessive analysis permitted us to try not to work unreasonably for harmless appendiceal mucocele.

The patient was a 85-year-old male. He had a positive screening waste mysterious blood test, so he was alluded to our organization for additional assessment and treatment. His level and weight were 168 cm and 60 kg. His general condition was great and he had no weight reduction. He had no pallor (Hb: 12.7 g/dL), hunger (Alb: 4.3 g/dL, CHE: 284 U/L), or strange research facility information including cancer markers (carcinoembryonic antigen: 3.3 ng/mL, carb antigen 19-9: 15 U/mL). He had hypertension and postoperative gallbladder stone. An ensuing colonoscopy uncovered a submucosal cancer 2 cm in measurement at the cecum with pad sign and well of lava sign. The outer layer of the cancer looked unblemished. Stomach registered tomography (CT) uncovered hand weight like typified cystic injury at the cecum. It was inside uniform, and neither enlarged lymph hubs nor intracystic knobs were recognized. In light of a determination of appendiceal mucinous cystadenoma, the patient went through laparoscopic medical procedure.

With the patient in a prostrate situation with the legs separated, a 12-mm trocar was presented in the umbilical part and pneumoperitoneum was then settled. Another 12-mm trocar was presented in the left upper midsection and 5-mm trocars in the left and right lower mid-region. Laparoscopic perception showed the completely expanded addendum. Further laparoscopic investigation didn't uncover ascites or enlarged lymph hubs. The tip of the informative supplement couldn't be uncovered on the grounds that it stuck firmly to the back mass of the cecum. In this way, we previously analyzed the foundation of the supplement including the cecal wall utilizing Endo-GIATM (Covidien). Then, the retrograde methodology was embraced to the tip of the addendum. At last, the growth was painstakingly extricated from the umbilical part utilizing Endo-catcherTM (Covidien). Neurotic conclusion during medical procedure uncovered that no threatening cells existed and careful edge was negative. Thus, lymph hub analyzation was not performed.

A gross pathologic assessment showed a 7.5 × 4.0 cm cystic construction with mucoid liquid. Minuscule assessment uncovered that the construction had a somewhat abnormal epithelium, viable with the conclusion of mucinous cystadenoma. There were no complexities. The patient was then released on the seventh postoperative day.

Appendiceal mucocele was first portrayed by Rokitansky [1]. It is the condition brought about by widening of a lumen because of a collection of bodily fluid. Its rate ranges somewhere in the range of 0.2 and 0.3% of all resected supplements [2, 3]. Appendiceal mucocele can be separated into 3 neurotic sorts: mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma. It is accounted for that the proportion of every rate is around 2: 5:1 [4].

With respect to the degree of cancer resection, straightforward appendectomy is adequate for mucosal hyperplasia and mucinous cystadenoma. However, if a cystadenocarcinoma is available, ileocecal resection or right hemicolectomy with lymph hub analyzation is demonstrated [5, 6, 7]. As of late, a few creators have revealed that right hemicolectomy gives no endurance advantage [8]. Dhage-Ivatury [1] have proposed a few variables about the determination of the sort of a medical procedure: (A) whether a mucocele is punctured, (B) whether the foundation of the supplement is engaged with the interaction, and (C) whether there are positive lymph hubs of mesoappendix and ileocolic vein [3].

Be that as it may, it is hard to separate harmless cancer as mucosal hyperplasia and mucinous cystadenoma from mucinous cystadenocarcinoma before medical procedure. In this way, there is a propensity that an oversurgery is performed to hyperplasia and mucinous cystadenoma. Moreover, assuming it is cracked and the topping switches off in the peritoneal cavity during medical procedure, there is high likelihood that pseudomyxoma peritonei will create. The forecast is so terrible, 5-year-endurance is 53-75% and 10-year-endurance is 10-32% [9, 10]. Along these lines, a few specialists feel that open a medical procedure ought to be inclined toward against laparoscopy [11].

For our situation, we found fountain of liquid magma sign, which is normal for appendiceal mucocele, and there were no dangerous factors, for example, intracystic knobs or enlarged lymph hubs in preoperative assessments [12]. We judged that lymph hub analyzation or right hemicolectomy were not required. In activity, to guarantee the careful edge, we performed appendectomy including the cecal wall. Accordingly, we could keep away from oversurgery to mucinous cystadenoma by exact preoperative determination.

In activity, puncturing a tumor is so significant not. For our situation, we initially couldn't show the entire of the growth. We initially took apart the foundation of the index and drew nearer retrogradely. Moreover, we made a point not to take the cancer by laparoscopic forceps and extricated it utilizing a plastic sack to keep away from bond of bodily fluid to the peritonea. Nonetheless, the clinical advantage of laparoscopic resection of appendiceal mucocele is by and by muddled. It very well may be done securely by outlining all together not to puncture a cancer. We imagine that laparoscopic resection will turn into a careful choice for the treatment of appendiceal mucocele.

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Masahiro Shiihara . Usefulness of the Volcano Sign in Preoperative Diagnosis and Surgical Approach of Appendiceal Mucinous Cystadenoma. International Journal of Gastroenterology and Hepatology 2022.