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Abstract: The patient, 81 years old, presented to our department with ascites and abdominal pain. After CT as well as MRI examination, thickening of the appendiceal wall was seen and serum examination showed significantly elevated tumor markers, and it was decided to perform surgery on him. After surgery, the tissue was sent for pathological examination, and it was determined to be a mucinous cystadenoma of the appendix.
Basic information】Male, 81 years old
Disease Type】Mucinous cystadenoma of the appendix
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】February 2021
Treatment plan】Surgical treatment (right hemicolectomy) + chemotherapy (oxaliplatin mannitol injection + calcium folinic acid for injection)
Treatment period】1 week of hospital admission, 3 months of follow-up
Effectiveness of treatment】Stable condition and gradual relief of discomfort symptoms
I. Initial consultation
An 81-year-old male patient, Mr. Wang, was admitted to our department by the emergency room. The patient pressed his hand on the right side of the abdomen with a painful expression, sweating a lot and making some moaning sounds from time to time. The patient’s family relayed that the patient had abdominal pain for a long time, starting from last night after dinner, and at first it was just a little painful, but later it felt heavier and heavier, affecting the patient’s sleep. The patient reported that he had been constipated for the past few days, with distension and pain in the lower abdomen, loss of appetite, and nausea and vomiting, but the symptoms could improve on their own. Further physical examination revealed that the patient had heavy ascites and was suspected to have intestinal tumor.
II. Treatment history
After the patient was admitted to the hospital, physical examination revealed that the patient had obvious ascites and the right lower abdomen was relatively hard. However, due to the interference of ascites, no obvious mass could be palpated, and ultrasound showed a small amount of ascites in the abdominal cavity. The tumor was seen to have penetrated the appendiceal wall and partially penetrated the whole appendix, and part of the cyst ruptured, resulting in mucinous ascites. Calcium folinic acid for injection was added as adjuvant chemotherapy.
III. Treatment effect
The surgical procedure was complicated because the patient’s tumor had infiltrated the whole appendix and the cyst had ruptured and spread to the abdominal cavity by implantation, resulting in mucinous ascites in the abdominal cavity and pseudomucinous tumor in the local peritoneum. In addition, due to the patient’s age and weak constitution, the recovery was slow after the operation, but the patient’s operation was smooth and there were no other special complications after the operation, and the patient was discharged after 1 week of hospitalization with no obvious discomfort. During the postoperative follow-up period, the patient indicated that his condition had stabilized, and the symptoms of nausea, vomiting, and lower abdominal distension were gradually relieved.
IV. Notes
We are glad that the patient’s condition has gradually stabilized after treatment, but due to the high degree of malignancy of this disease, the patient was carefully instructed at the time of discharge to undergo regular review after discharge, and if any abdominal discomfort occurs during the follow-up period, he should immediately seek medical examination to avoid delaying the diagnosis and treatment of the disease. Because of the patient’s age and poor physical condition, poor appetite and poor nutritional status after surgery, the patient can move down more often. Choose some easily digestible and highly nutritious food in the diet, try to improve the body immunity, and keep optimistic mood to avoid negative mentality such as depression.
V. Personal insight
Although mucinous cystadenoma of the appendix is relatively rare, there is a high possibility of recurrence, especially the cyst rupture is prone to abdominal dissemination. Therefore, in addition to regular review at the hospital, postoperative chemotherapy is particularly important in this patient, which can largely improve the patient’s prognosis.
Generally, patients of advanced age like the one in this article undergoing surgery for malignant appendiceal cancer are subjected to general anesthesia with tracheal intubation, more postoperative respiratory secretions, and longer postoperative bed rest, so secondary pulmonary infections should be prevented.