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.