There are various surgical approaches to the giant, mucin-filled dilated appendix. Appendectomy through a small incision is challenging due to adhesions and leads the surgeon to blindly perform blunt dissection. Rupture contaminates the peritoneal cavity and wound, and in the 20% of cases which harbor malignancy, assures tumor recurrence often in the form of pseudomyxoma peritonei. However, formal laparotomy seems unnecessary for all patients with mucocele. We contend that laparoscopy is the optimal approach to this disease by allowing superior visualization and dissection with minimal manipulation of the often tense appendix.

We present a 70-year old male with an incidentally found greatly dilated appendix. Complete work-up including colonoscopy did not reveal synchronous neoplasms. The patient underwent laparoscopic appendectomy for a pathological confirmed mucinous cystadenoma.

Mucocele of the appendix accounts for 1% of all resections. Luminal distention with mucus is brought upon by benign or malignant proliferation of the mucosa. Pathological review is critical to diagnose benign mucocele, mucinous cystadenoma, and malignant mucinous cystadenocarcinoma. Most cases can be treated by simple appendectomy; however, malignancy requires formal right hemicolectomy for staging and treatment. Although there are many surgical approaches to this disease, laparoscopy provides the surgeon with the greatest treatment flexibility.