Incidentally Discovered Ruptured Mucinous Appendiceal Neoplasms. What About TheSurgical Approach?

Mucocele of the appendix is an uncommon pathological condition often discovered incidentally during surgery. It may arise from non-neoplastic or neoplastic lesions, necessitating histopathological examination for definitive diagnosis. Failure to identify and manage this condition preoperatively can result in rupture, spilling mucin into the peritoneal cavity, and causing pseudomyxoma peritonei (PMP)—a severe complication with poor prognosis. This literature review aims to consolidate information regarding ruptured mucinous appendiceal neoplasms to minimize the risk of PMP and provide guidance on evidence-based surgical management. The review evaluates epidemiology, clinical manifestations, complications, pathology, diagnostic approaches, and treatment strategies. A meticulous surgical excision remains the cornerstone of treatment, with open surgery preferred over laparoscopy to reduce the risk of spillage. Preoperative diagnosis, using imaging modalities such as computed tomography (CT) and ultrasonography, is critical to detect potential malignancies. Primary care physicians play a pivotal role in early recognition and timely referral to prevent complications and optimize outcomes. In cases with advanced patients with diffuse mucinous dissemination after mucocele rupture, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are recommended, however the benefit of prophylactic CRS + HIPEC in high-risk patients without peritoneal spread is controversial.