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Laparoscopic ileo-caecal resection for appendicular mucocele

Authors

Abstract

This video demonstrates a laparoscopic ileocecal resection using a medial approach in a patient with appendicular mucocele. The mesentery is divided using ligasure. The anastamosis is performed extracorporeally.

Classification

routine cases

Keywords

appendicular mucocele, laparoscopic ileocecal resection, medial approach

Media type

Duration

07'00''

Publication

2006-10

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E-publication

WeBSurg.com, Oct 2006;6(10).
URL: http://www.websurg.com/doi-vd01en1991.htm

Laparoscopic ileo-caecal resection for appendicular mucocele

1. Case presentation 00'14''

In this video, we show the case of a 50-year-old woman presented to our emergency room with chief complaint of bleeding per rectum. The patient underwent colonoscopy which showed an external compression of the caecum close to the ileo caecal valve. No erosions were found and the bleeding was attributed to hemorrhoids. An abdominal ultrasound and CT-scan were also performed; the ultrasound showed multiple echogenic layers along a dilated appendix with the appearance of onion skin like circles. The CT-scan images confirmed a capsulated cystic mass close to the caecum, with calcification of the wall suggesting the diagnosis of appendiceal mucocele.

2. Trocar placement and exploration 00'55''

The patient is placed supine with the surgeon on the left side. The optical trocar is placed in the per-umbilical area. A further trocar is inserted in the epigastric region for the right hand of the surgeon; a 5 mm supra-pubic trocar is placed on the left-hand operative port, an additional 5mm port is inserted in the right flank of the transverse umbilical line. Initial laparoscopic exploration is performed. Upon inspection, we found a large mucocele with a wide base on the caecum. The type of surgical treatment is related to the dimension and the histology of the mucocele. Caecal resection is indicated for a cystadenoma with a large base. According to the literature, we began the steps to perform an ileo-caecal resection. Mucocele of the appendix is rare but the frequency of appendicitis as a general surgical problem is so large that a general surgeon may encounter a mucocele several times every year. Proper treatment of mucocele is critical because if managed incorrectly it may progress to pseudomyxoma peritonei.

3. Start of procedure 02'15''

The peritoneum is opened on the two sides of the ileo-cecal vessels, which once identified are isolated and divided with the Ligasure. The mesentery of the right colon is divided using the Ligasure coagulation device. The dissection is continued in order to isolate the ileo-colic junction. The Ligasure is ideal because it controls bleeding from small vessels in the tissue. The posterior attachments of the colon are divided. The hepatic flexure is divided in order to achieve adequate mobilisation. Once the attachments have been divided and the right colon is fully mobilised, it is resected with the linear stapler. A mini-laparotomy is performed on the umbilical port and the specimen is brought out through a wound protector to avoid any contamination. Once the resection is completed, a lateral-lateral anastomosis is performed. The mesentery between the small bowel and the colon is closed with a 3/0 Vicryl running suture.

4. Post-operative 07'07''

The patient postoperative course was uneventful and she was discharged on postoperative day 5. The final pathology showed mucocele caused by mucinous cystadenoma.

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