Perforated mucinous cystadenoma of the vermiform appendix: an overview in reasoning clinical decisions.
Recent advances in the management of appendiceal mucinous neoplasms (AMN) such as peritonectomy combined with hyperthermic intraperitoneal chemotherapy have introduced new standards of care. However, many dilemmas are encountered in decision making as in the following patient. A 74-year-old woman was admitted with an appendiceal cystadenoma found in a preadmission CT scan. However, the tumour was not documented by the in hospital investigation due to its perforation and its reduction in size. Consequently, a series of management dilemmas were encountered that were solved by cautious evaluation of the pre and peroperative findings. She was submitted to a right hemicolectomy. A spontaneous perforation was suspected, but the accurate diagnosis was documented postoperatively by histopathology. This paradigm motivated this review which concluded that reasoning clinical decisions in the light of recent advances and appropriate care based on the disease-stage are essential for an optimal outcome in the management of AMN.
Fourth Surgery Department, National & Kapodistrian University of Athens, School of Medicine, University General Hospital Attikon, Athens, Greece. ipapado@med.uoa.gr
Iordanis N
IN
Papadopoulos
Spyridon
S
Christodoulou
Panayiotis
P
Kokoropoulos
George
G
Konstantudakis
Nikolaos
N
Economopoulos
Vassilia
V
Leontara
D000368:Aged; D001063:Appendiceal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D001065:Appendix / Q000473:pathology / Q000601:surgery; D001706:Biopsy; D003082:Colectomy / Q000379:methods; D003113:Colonoscopy; D018291:Cystadenoma, Mucinous / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003657:Decision Making; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009367:Neoplasm Staging; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography