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QUIZ No. 15
Case 15
A 40-year-old female presents with progressive abdominal distension and vague abdominal pain. CT and MRI of the abdomen were obtained. What is the most likely diagnosis?
Visitor No:
Diagnosis: Ruptured Appendiceal Mucocele with Pseudomyxoma Peritonei
Findings: Cystic dilatation of the appendix with irregular wall and focal discontinuity. There is associated low-attenuation mucinous ascites with scalloping of the liver surface.
Discussion
Ø Appendiceal mucocele represents mucin-filled dilatation of the appendix, often due to mucinous neoplasm.
Ø Rupture leads to dissemination of mucin-secreting epithelial cells into the peritoneal cavity → pseudomyxoma peritonei.
Ø The disease is characterized by progressive accumulation of mucin within the peritoneum.
Ø Imaging hallmark: visceral scalloping due to mass effect of mucin.
Ø Intraoperative hallmark: copious gelatinous (“jelly belly”) mucin deposits coating abdominal structures.
Ø Management includes cytoreductive surgery with HIPEC.
Teaching pearl:
è Scalloping on CT + gelatinous deposits intraoperatively = pathognomonic combination
Always search for appendiceal primary in mucinous ascites
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