Mucocele of the appendix: report of two cases

Appendiceal mucocele is a rare pathological entity characterized by luminal distension due to mucin accumulation, arising from both benign and malignant etiologies. We report two contrasting cases highlighting the diagnostic and therapeutic challenges of this condition. The first case involved a 37-year-old male with features of acute appendicitis and a dilated appendix on imaging. Surgery revealed a mucocele with localized perforation, and histopathology confirmed eosinophilic appendicitis (EA), a rare variant previously unreported as a cause of mucocele. The second case was a 53-year-old female with chronic abdominal pain and a cystic appendiceal lesion on imaging, later diagnosed intraoperatively as mucinous adenocarcinoma, prompting right hemicolectomy. Despite surgical intervention, the patient succumbed to postoperative sepsis and complications. These cases underscore the broad spectrum of presentations, from benign inflammation to malignancy, and the limitations of preoperative imaging in definitive diagnosis. EA-associated mucocele and perforation is a novel finding. Surgical management remains the cornerstone of treatment, guided by intraoperative and histopathological findings. High clinical suspicion is warranted, especially in older patients with anemia or atypical symptoms, to avoid delayed diagnosis of malignancy. This series emphasizes the need for individualized surgical approaches and highlights underrecognized etiologies such as EA in appendiceal mucocele. • Etiologies of mucocele of appendix range from benign conditions such as inflammation, epithelial proliferation, fecoliths, or parasites, to malignant ones, including mucinous neoplasms and adenocarcinoma. • A CECT scan can detect mucocele of appendix but cannot specifically distinguish between benign and malignant causes. • Eosinophilic appendicitis is a rare cause of mucocele of appendix, characterized predominantly by eosinophilic infiltration. • Surgery remains the standard of care in mucocele of appendix. Intraoperative findings and a frozen section biopsy determine the extent of surgery.