24 March 2020 : Case report
A Case of Strangulation Ileus Due to a Low-Grade Appendiceal Mucinous Neoplasm
Management of emergency care, Rare disease
Ryohei Takei1ABCDEF*, Keiichiro Kanamoto1B, Yuta Tamaru1B, Koki Nojima1B, Kazuyoshi Mitta1B, Ryosuke Zaimoku1BC, Ayako Kanamoto1D, Hirohumi Terakawa1D, Yuki Higashi1D, Yuji Tsukioka1DF, Kiyoshi Takagawa2CD, Masato Kiriyama1DEDOI: 10.12659/AJCR.922405
Am J Case Rep 2020; 21:e922405
Abstract
BACKGROUND: Strangulation ileus is caused by external obstruction to the small bowel, which results in ischemia and loss of bowel peristalsis. Low-grade appendiceal mucinous neoplasm (LAMN) is a low-grade adenocarcinoma that arises in the appendix. LAMN is usually asymptomatic but can present with appendiceal rupture and pseudomyxoma peritonei (PMP). This report is of a rare presentation of LAMN with strangulation ileus in a 92-year-old man.
CASE REPORT: A 92-year-old man was admitted to the emergency room with sudden onset of lower abdominal pain and abdominal distension. Laboratory investigations showed a leukocytosis with a white blood cell (WBC) count of 14.6×10³/μL with 85.5% neutrophils, blood urea nitrogen (BUN) of 26.6 mg/dL, and serum creatinine of 2.6 mg/dL, consistent with acute renal failure. Arterial blood gas analysis showed lactic acidosis (pH of 7.11) with a base excess of –20.8 mmol/L and lactate of 13.7 mmol/L. Abdominal computed tomography (CT) showed ascites and a dilated obstructed closed loop of the distal ileum associated with an external mass (3.9×2.8 cm). An initial diagnosis was of strangulation ileus due to Meckel’s diverticulum. Emergency ileocecal resection was performed. Histopathology showed a low-grade mucinous tumor arising from the mucosa of the appendix, consistent with LAMN. At a 13-month follow-up, the patient was well with no tumor recurrence.
CONCLUSIONS: This report is of a rare case of LAMN that presented as a surgical emergency with strangulation ileus.
Keywords: Appendiceal Neoplasms, case reports, Ileus, Adenocarcinoma, Mucinous, Aged, 80 and over, Emergency Service, Hospital, Meckel Diverticulum
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