Case presentation
A 68-years-old male patient without any underlined disease, was admitted to the general surgery department with abdominal distention, weight loss and abdominal pain. During physical examination, significant distention and a palpable mass in the periumbilical area above the pelvic cavity with expansion to right side were identified. The abdomen was soft and smooth, with no tenderness or guarding. In the lab data, no leukocytosis (WBC: 7300), mild anemia (HB: 12.5 mg/dl) were found. Spiral computed tomography of the abdomen and pelvic region revealed a normal right kidney displaced by a large cystic lesion in retroperitonium on the right side, with a multiloculated cystic appearance and is infiltrating part of the right psoas muscle.it extends inferiorly to the level of the right side of the lower abdomen and pelvic cavity and also has a pressure effect over the adjacent part of the urinary bladder. (figure1)
The patient underwent exploratory laparotomy. The appendix tumor which invaded the visceral peritoneum was removed, dissected and divided from the retroperitoneum. Right hemicolectomy was done from 10 cm before the ileocecal valve up to mid transverse colon. End to end ileocolic anastomosis was done. In addition, the multiloculated mucinous collection was drained, and the cavity walls were sent to pathology. Postoperative histopathological analyses revealed that the tumor size was 4*2.5*1 cm. and tumor type was ‘Mucinous appendiceal neoplasm’ However, no metastasis or lymph node involvement was detected. (figure2)
The patient had an uneventful postoperative course and was discharged 10 days after surgery and we refer him to an oncologist, oncologist has prescribed 8 courses of chemotherapy (FOLFOX regimen) every 2 weeks for prophylaxis.