title: Preoperative assessment and treatment of appendiceal mucocele complicated by acute torsion: a case report.
abstract: BACKGROUND
  Mucus-producing tumours of the appendix or mucoceles can, if left untreated, lead to dissemination of its contents into the peritoneal cavity causing substantial morbidity to the patient. Symptoms for complicated mucoceles can mimic those of acute appendicitis and the final diagnosis is most likely made intraoperatively. We here present a case that is, to our knowledge, one of only ten described in the literature and the first to characterize torsion of an appendiceal mucocele with abdominal magnetic resonance imaging.
  
  
  METHODS
  The patient, a 34-year-old Caucasian female presented at the emergency department with acute abdominal pain in the right lower quadrant. Initial diagnostic work-up including ultrasonography and abdominal magnetic resonance imaging showed a large tubular mass at the base of the appendix with indirect signs of torsion. A laparoscopic appendectomy was performed the following day where the finding was confirmed. The patient went on to have an uneventful recovery and was discharged from the hospital on the first postoperative day.
  
  
  CONCLUSIONS
  Magnetic resonance imaging is a useful tool in identifying unknown lesions of the appendix and should be considered the primary imaging modality in especially younger patients requiring diagnostic imaging. In this case the preoperative imaging findings aided in choosing the correct timing and treatment option for the patient.
authors.affiliation: Department of Surgery, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland. christoffer.stark@utu.fi.
authors.forename: Christoffer
authors.initials: C
authors.lastname: Stark
authors.forename: Mikko
authors.initials: M
authors.lastname: Jousi
authors.forename: Berndt
authors.initials: B
authors.lastname: Enholm
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology; D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001065:Appendix / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002429:Cecal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D009078:Mucocele / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D009336:Necrosis; D011300:Preoperative Care / Q000379:methods*; D014102:Torsion Abnormality / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014463:Ultrasonography