An Appendiceal Mucocele Presenting With Concurrent Gynecological Pathology: A Case Report

Appendiceal mucocele is a rare condition characterized by cystic distension of the appendix due to mucin accumulation, presenting a notable diagnostic dilemma that frequently mimics adnexal or ovarian masses in female patients. We describe a 25-year-old female who presented with right iliac fossa pain and was previously managed conservatively for an assumed appendiceal abscess, while concurrently undergoing active follow-up for a known ovarian cyst. Initial ultrasonography revealed a suspicious left adnexal mass, but subsequent computed tomography imaging demonstrated a fluid-filled, dilated appendix measuring 7.4 cm in length and 1.6 cm in maximum diameter, clearly exceeding the diagnostic threshold of 15 mm, alongside a thick-walled left ovarian cystic mass. The patient underwent a joint open laparotomy via a suprapubic transverse incision to address the dual pathology. Meticulous mobilization techniques using moist laparotomy pads were employed to prevent iatrogenic mucocele rupture. The appendiceal base was macroscopically free of disease, and an appendectomy was successfully performed alongside the gynecological resection. Histopathology confirmed a non-neoplastic appendiceal mucocele (retention cyst) and a left ovarian endometriotic cyst. The patient experienced an uneventful recovery and remains asymptomatic on outpatient follow-up. This case highlights the complexity of overlapping right lower quadrant pathologies and underscores the critical need for a high index of clinical suspicion and multidisciplinary surgical planning to ensure safe enucleation and prevent pseudomyxoma peritonei.