{
    "abstract": "Low-grade appendiceal mucinous neoplasms (LAMNs) are rare entities that can present significant challenges when discovered incidentally by general surgeons during surgery or through postoperative pathology. These lesions may mimic common abdominal conditions and are often not suspected preoperatively.\nWe present a case series of five patients in whom appendiceal mucoceles were incidentally identified either intraoperatively or on postoperative pathological examination. The patients ranged from 36 to 79\u00a0years old and presented with symptoms such as right lower quadrant pain, initially attributed to appendicitis, ovarian torsion, or other gynecological conditions. Intraoperative findings varied from dilated appendices with mucinous content to large cystic masses involving adjacent structures.\nIn each case, the general surgeon had to make immediate decisions regarding management. Surgical interventions included laparoscopic appendectomy and open right hemicolectomy, with an emphasis on careful handling to prevent rupture and spillage of mucin. Postoperative pathology confirmed LAMNs, with tumor stages ranging from pTis to pT4a. Some patients required additional procedures, such as cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), due to the presence of acellular mucin or peritoneal involvement. The discussion focuses on practical guidance for general surgeons when faced with an incidental appendiceal mucocele. Key recommendations include avoiding intraoperative rupture by gentle handling, assessing the need for extended resection based on intraoperative findings, and ensuring thorough communication with pathology for accurate staging. Postoperative management should involve reviewing pathology reports carefully, considering referral to a multidisciplinary team for higher-stage tumors, and implementing long-term surveillance protocols due to the risk of recurrence.\nGeneral surgeons play a critical role in the initial management of incidentally discovered appendiceal mucoceles. Prompt recognition and appropriate intraoperative decision-making are essential to optimize patient outcomes. By adhering to careful surgical techniques and collaborating with multidisciplinary teams, surgeons can effectively manage these unexpected findings and mitigate potential complications associated with LAMNs.",
    "authors": [
        {
            "affiliation": "Northeast Georgia Health System, Graduate Medical Education Department, 743 Spring Street NE, Gainesville, GA 30501, United States of America. Electronic address: Nathaniel.grabill@nghs.com.",
            "firstname": "Nathaniel",
            "initials": "N",
            "lastname": "Grabill"
        },
        {
            "affiliation": "Northeast Georgia Health System, Graduate Medical Education Department, 743 Spring Street NE, Gainesville, GA 30501, United States of America.",
            "firstname": "Mena",
            "initials": "M",
            "lastname": "Louis"
        },
        {
            "affiliation": "Northeast Georgia Health System, Graduate Medical Education Department, 743 Spring Street NE, Gainesville, GA 30501, United States of America. Electronic address: jonathan.ray@nghs.com.",
            "firstname": "Jonathan W",
            "initials": "JW",
            "lastname": "Ray"
        },
        {
            "affiliation": "Northeast Georgia Health System, Graduate Medical Education Department, 743 Spring Street NE, Gainesville, GA 30501, United States of America. Electronic address: ana.tucker@nghs.com.",
            "firstname": "Ana",
            "initials": "A",
            "lastname": "Tucker"
        },
        {
            "affiliation": "Northeast Georgia Health System, Braselton General Surgery Department, 1404 River Place, Braselton, GA 30517, United States of America. Electronic address: travelyan.walker@nghs.com.",
            "firstname": "Travelyan",
            "initials": "T",
            "lastname": "Walker"
        },
        {
            "affiliation": "Northeast Georgia Health System, Braselton General Surgery Department, 1404 River Place, Braselton, GA 30517, United States of America. Electronic address: james.chambers@nghs.com.",
            "firstname": "James",
            "initials": "J",
            "lastname": "Chambers"
        }
    ],
    "conclusions": "General surgeons play a critical role in the initial management of incidentally discovered appendiceal mucoceles. Prompt recognition and appropriate intraoperative decision-making are essential to optimize patient outcomes. By adhering to careful surgical techniques and collaborating with multidisciplinary teams, surgeons can effectively manage these unexpected findings and mitigate potential complications associated with LAMNs.",
    "copyrights": "Copyright \u00a9 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.",
    "doi": "10.1016/j.ijscr.2025.111281",
    "journal": "International journal of surgery case reports",
    "keywords": [
        "Appendectomy",
        "Appendiceal neoplasm",
        "Colectomy",
        "Hemicolectomy",
        "Mucocele",
        "Pseudomyxoma peritonei"
    ],
    "methods": null,
    "publication_date": "2025-04-26",
    "pubmed_id": "40279990",
    "results": "In each case, the general surgeon had to make immediate decisions regarding management. Surgical interventions included laparoscopic appendectomy and open right hemicolectomy, with an emphasis on careful handling to prevent rupture and spillage of mucin. Postoperative pathology confirmed LAMNs, with tumor stages ranging from pTis to pT4a. Some patients required additional procedures, such as cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), due to the presence of acellular mucin or peritoneal involvement. The discussion focuses on practical guidance for general surgeons when faced with an incidental appendiceal mucocele. Key recommendations include avoiding intraoperative rupture by gentle handling, assessing the need for extended resection based on intraoperative findings, and ensuring thorough communication with pathology for accurate staging. Postoperative management should involve reviewing pathology reports carefully, considering referral to a multidisciplinary team for higher-stage tumors, and implementing long-term surveillance protocols due to the risk of recurrence.",
    "title": "Incidental appendiceal mucocele discovery: A case series and literature review.",
    "xml": "<Element 'PubmedArticle' at 0x788506f03a10>"
}