Salvadora Delgado (Gastrointestinal surgery senior consultant)
Xavier Morales Sevillano (Gastrointestinal and Emergency Surgery Specialist)
Hospital Clínic, Barcelona, Spain
A 48-year-old female with no relevant medical record came to the emergency room describing 24-hour abdominal pain and fever. In the evaluation she displayed tenderness at the right iliac fossa, WBC=14,500/mm3 RCP = 18,28 mg/dL. Her urine test was normal and her urine pregnancy test was negative.
Further investigation was performed by means of abdominal and gynecological US that were unspecific. The CT-Scan showed a suggestive tumoral image (FIG. 1, yellow arrow) at the ileocecal-valve (FIG. 1, above the uterus, red arrow) with inflammatory changes and local adenopathies (green arrow).
The patient was admitted and underwent a laparoscopic right colectomy. Laparoscopic examination of the abdominal cavity revealed a mass that involved the cecum, the distal ileum and the appendix. No other lesions were found. The right colic vessels were dissected and ligated by MIS and en-bloc resection was performed, obtaining macroscopic free margins.
Surgery took 75 minutes and was uneventful. The patient presented a mild ileus that was resolved requiring no parenteral nutritional support and left hospital on the 5th day after the surgery.
Pathological examination showed anendometrial implant of 3.7 x 3.9cm that was compressing the appendicular lumen and causing a microperforated mucocele. There was no neoplasia.