APPENDICEAL MUCOCELE - CONTRAINDICATION TO LAPAROSCOPIC APPENDECTOMY

Indications and contraindications to laparoscopic surgery continue to be refined. Laparoscopic appendectomy for acute appendicitis is freque ntly selected by patients and surgeons, and clinical studies show it t o be a reasonable alternative. In this case study, laparoscopic surger y was used to resect an appendiceal mucocele caused by a nonperforated mucinous adenocarcinoma. Implants of mucinous tumor were found widely disseminated on peritoneal surfaces at laparotomy 9 months later. As a result of this case study, the authors suggest that when an appendic eal mucinous tumor is encountered at laparoscopy, a special situation requiring totally atraumatic appendectomy is indicated. This clinical situation should be considered an indication for conversion to open ap pendectomy, All appendiceal tumors, including the most benign-appearin g adenomas, can result in diffuse peritoneal implantation. This is the first report of an appendiceal mucinous tumor resected by laparoscopy associated with subsequent diffuse peritoneal carcinomatosis. This pa tient presentation reaffirms that dis semination of cancer may be asso ciated with laparoscopic resection of structures containing a malignan cy.