LAUSR

A 29-year-old female patient presented to the emergency department with 12 h sudden onset of epigastric pain and nausea. On history this was the first episode of pain, no associated temperature or urinary symptoms. There was no history of gallstones or excessive consumption of alcohol. On clinical examination, the abdomen was not distended and there was minimal tenderness in the epigastrium and right lower abdomen. Blood picture including lipase was within normal limits. In view of inconsistencies in history and examination, multiphase computed tomography scan of the abdomen was performed, which was suggestive of mucocele of appendix with no free fluid in the peritoneal cavity. In view of ongoing pain and computed tomography findings, intervention in the form of laparoscopy was undertaken. At laparoscopy, there was evidence of torsion of mucocele of appendix (Fig. 1). No evidence of any other visceral or peritoneal disease was noted. Detorsion (Fig. 2) followed by appendicectomy was carried out as macroscopically there was clear margin at the base of the appendix. The specimen was retrieved without rupture using a retrieval bag. The patient tolerated the procedure well and was discharged on day 2. Histological evaluation revealed a 45-mm dilated appendix with abundant extra-cellular mucin. There was no evidence of serosal involvement or perforation. The proximal margins were clear and the final diagnosis of low-grade appendiceal mucinous neoplasm (AJCC grade 1) was confirmed (Fig. 3). Mucocele of the appendix is a term used to describe an appendix that is grossly distended by mucus. The presentation of mucocele