The content of mucous cysts is a thick, transparent, gelatinous mass with a positive reaction to mucin or serous fluid, in which an admixture of blood is sometimes found, and the contents become darker. Some cysts contain different sizes - from eggs to pea - grains, which are partially welded together by a small amount of mucus( mycoglobulosis of the appendix).
For the first time, the mucous cusp of the appendix was described by Rokitansky in 1842. The term "mucocele" was proposed for these cysts of Fere in 1877.
Appendectal cysts are benign, but their clinical significance is immeasurably increased due to such a serious and frequent complication,what is the breakthrough of the cyst and the exit of the mucous masses into the abdominal cavity, followed by reactive inflammation and the formation of the so-called sludge( pseudomixoma) of the abdominal cavity, the course of which is very malignant and moa result in death.
The development of pseudomixoma from the blasted cyst of the appendix was described in 1901 by E. Frenkel. Before that, the only source of pseudomixoma was considered an ovarian cyst.
Complete cysts of the appendix are distinguished, when the whole length of the lumen of the appendage serves as the cavity of the cyst, and intramural - when the cyst is formed due to protrusion of the part of the appendix wall. According to most authors, mucous cysts have a retentional nature, although it is impossible to explain the occurrence of so-called open cysts from the point of view of retention theory.
Cysts vary in size from small( 2-5 cm in diameter) to giant( 67 cm in circumference).
In the wall of a cystically altered process, histological examination shows a pattern of atrophy and sclerosis of the muscular layer, sometimes complete absence of the mucosa and follicles. The appendix wall is in most cases thinned.
Cysts of the appendix are a rare disease. GI Varnovitsky reports that in the literature available to him, about 500 cases of this disease are mentioned. According to his data, mucoceles occur in 0.15% of all appendectomies( according to various statisticians - 0.08-0.35%).VM Grubnik on 1473 operated on appendicitis observed two such patients. IS Kaledin and E. K. Duplik for 2842 appendectomies with acute appendicitis, there were four cases of cysts of the appendix( 0.14%).
According to our observations, 755 appendectomies met two cases of mucosal appendicitis cysts.
The clinic of the cusp of the appendix corresponds to the pattern of chronic or acute appendicitis.
As with appendicitis inflammation, and in cases of appendicular cysts, patients note different pain intensities in the right ileal region or under the spoon, less often throughout the abdomen. Some authors indicate that pains arose or intensified with sudden movements. The latter observation is more relevant to those cases where cysts of considerable size are found.
Dyspeptic phenomena in the form of eructations, nausea, vomiting, deterioration of appetite were noted. At an objective inspection of such patients symptoms of Shchetkin-Blumberg, Rovzinga, Sitkovsky, Krymov, Mikhelson are found out. The above signs, of course, do not have specificity in this disease. A more reliable symptom that makes it possible to suspect a mucocel is a palpable tumor in the right ileal region. However, the value of this symptom is significantly reduced with a marked strain of the muscles of the anterior abdominal wall.
There are data on successful cases of X-ray diagnosis of appendicular cysts.
Cysts of the appendix can cause other diseases, and then in the clinical picture the signs of these diseases prevail. OI Vaysfeld, VA Malkhasyan and OK Khachatryan, and IM Popov described patients who were operated for intestinal obstruction caused by a cusp of the appendix.
In the literature available to us, we only once met the description of the case of twisting of the cvist of the appendix. Given the exceptional rarity of such a serious complication, such as the twisting of the leg of the cuspidum of the appendix, we decided to share our observation.
Patient I., 50 years old, entered the surgical department of the hospital at 20:00.30 / IV.with complaints of severe pain in the lower abdomen, especially above the pubis and in the right iliac region, chills, fever, nausea, vomiting, general weakness.
Abdominal pains have been troubling for the past 6-7 years, are paroxysmal, appear or worsen when walking, sudden turns of the trunk and sudden movements during physical work. Two years before she applied for medical help, she was examined by a gynecologist who diagnosed: ovarian cyst and offered surgical treatment, which the patient refused.
The day before the admission - 29 / IV during the whitewashing of the apartment the patient again felt pains in the lower abdomen, the intensity of which gradually increased. By the morning of the following day, the pain did not stop, nausea and vomiting appeared, and in this connection I was forced to go and call an ambulance.
Objectively: 112 beats per minute, satisfactory filling, rhythmic, strained, blood pressure - 140 and 85 mm Hg. Art.
The abdomen is slightly inflated, its right half is behind when breathing. At palpation - a protective muscle tension and soreness in the right ileal region and above the pubis. Here the symptom of Shchetkin-Blumberg is sharply positive. Symptom Pasternatsky fuzzy right. The temperature is 39 ° C. The external genitalia are like those of a woman giving birth. Mucous of the vagina - pink. The cervix in the mirrors is clean, cylindrical. The position and size of the uterus are not determined because of the severe soreness and tension of the anterior abdominal wall. In the region of the right appendages, a sharply painful strained tumor, the size of the head of the newborn, significantly protruding the posterior and lateral vaults of the vagina is determined.
Preliminary diagnosis: cyst of the right ovary with a twisting of the legs.
30 / IV at 21 hours.30 min.operation - lower middle laparotomy.
The operating field is processed according to Pirogov. Anesthesia( etheric-oxygen anesthesia).The median incision from the navel to the lobe is layered open the anterior abdominal wall. By opening the abdominal cavity a significant amount of serous-hemorrhagic effusion was released, there was swelling and hyperemia of the parietal peritoneum. The wound is the epiploon, the lower edge of which is fixed in a small pelvis, where a large, tightly-elastic consistency is detected by the tumor. The tumor is difficult to dislocate in the incision after separation of the fusion with the lower edge of the omentum. It is a cystic formation of a grayish-white color on a broad leg, which is twisted around the axis by 360 °.The peritoneum covering the tumor is hyperemic, edematous. The base of the leg is the cecum. The distal part of the tumor has a diameter of 15 cm and a circumference of 37 cm. The proximal part is delimited from the caecum by a shallow circular groove. Its diameter is 6.5 cm. The appendix was not found. On the border with the cecum, the tumor is cut off. The content of cystic formation is a homogeneous, gelatinous, not quite transparent, yellowish white color. The cavity and cysts are connected with an opening 2.5 cm in size, with a lumen of the cecum, from which the contents of the mucous nature are released. Resection of the tip of the cecum was performed. At inspection of a uterus and appendages of a pathology it is not revealed. The abdominal cavity is drained, with a rubber tube. Layer stitches on the wound. Aseptic dressing. Through the rubber drainage in the abdominal cavity 600 thousand units have been introduced.penicillin, 750 thousand units.colimycin.
The postoperative period proceeded without complications. The wound healed by primary tension.
The remote cyst was examined in the regional pathohistological laboratory. Pathohistological diagnosis is an acute inflammatory process in the wall of a cystic degenerate appendix.
The patient was examined three months after discharge. Feels healthy .
Our observation is of interest in the sense that here we have met with the so-called open cyst of the appendix, when the proximal part of the cystically altered appendix is freely communicating with the cecum. To explain the nature of such cysts, retention theory is inapplicable. In such cases, apparently, there is a real tumor growth.