Acute abdomen due to ileal perforation with an unexpected appendiceal mucocele: an intraoperative diagnostic challenge

Abstract

Acute abdomen secondary to intestinal perforation is a life-threatening surgical emergency that requires prompt diagnosis and intervention. Appendiceal mucocele is a rare entity that is frequently discovered incidentally and may carry significant clinical implications due to the risk of pseudomyxoma peritonei if rupture occurs. We report the case of an 82-year-old female who presented with a 2-day history of diffuse abdominal pain, nausea, decreased bowel movements, leukocytosis, metabolic acidosis, and signs of peritoneal irritation. Computed tomography demonstrated free intraperitoneal air and fluid collections suggestive of intestinal perforation. Emergency exploratory laparotomy revealed fecal peritonitis secondary to distal ileal perforation with transmural necrosis. Intraoperatively, an incidental dilated appendix consistent with appendiceal mucocele was also identified. Surgical management included small bowel resection with terminal ileostomy and appendectomy. Histopathological examination confirmed ischemic ileal perforation and appendiceal mucocele. This case highlights the diagnostic complexity of acute abdomen and emphasizes the importance of meticulous intraoperative exploration, as unexpected findings may alter surgical management and influence outcomes. Careful recognition and treatment of incidental appendiceal mucocele are essential to prevent complications such as pseudomyxoma peritonei.