Torsion of a necrotic appendiceal mucocele presenting as acute abdomen: a rare case report

Torsion of the vermiform appendix is rare. When torsion involves an appendiceal mucocele, timely surgical management, and avoidance of rupture are essential to prevent intraperitoneal mucin spillage. A 68-year-old woman presented with 12 h history of severe lower abdominal pain. Examination revealed marked lower abdomen rebound tenderness and her laboratory tests showed leukocytosis and elevated C-reactive protein. Urgent computed tomography demonstrated a 9 × 3.4 cm predominantly cystic mass posterior to the uterus with mural calcifications, consistent with an appendiceal mucocele. Emergency laparotomy revealed a necrotic appendiceal mucocele with complete torsion. The lesion was resected intact. Histopathology confirmed an appendiceal mucocele. The patient had an uncomplicated recovery and remains in excellent condition 3 months postoperatively. Appendiceal mucocele torsion should be considered in acute abdomen with a cystic pelvic mass on computed tomography. Intact resection is a key operative principle.