Diagnostic challenges in appendiceal mucocele mimicking acute appendicitis: a three-case experience

Introduction and importance: Appendiceal mucocele is a rare pathological condition characterized by the cystic enlargement of the appendix due to mucus accumulation. Clinically, it can mimic acute appendicitis or, less commonly, neoplastic lesions such as carcinoid tumors, creating diagnostic uncertainty. Accurate recognition during surgery and intact removal are essential to prevent rupture and subsequent pseudomyxoma peritonei. Presentation of cases: We describe three middle-aged female patients who presented with symptoms suggestive of acute appendicitis. The first case was a 40-year-old woman with right lower quadrant pain, nausea, and low-grade fever. The second case, a 36-year-old woman, presented with similar symptoms and was found intraoperatively to have a mass resembling a carcinoid tumor. The third patient, a 50-year-old diabetic woman, presented with right lower quadrant pain, vomiting, and fever. All underwent open appendectomy with intact removal of the appendix. Histopathology confirmed benign mucocele in all cases, with no evidence of malignancy. Postoperative recovery was uneventful, and all patients remained symptom-free during follow-up. Clinical discussion: These cases highlight the diagnostic challenges associated with appendiceal mucocele, which can mimic both inflammatory and neoplastic appendiceal conditions. Despite advances in imaging, preoperative diagnosis is often difficult, particularly in low-resource settings. Careful surgical technique to prevent rupture, combined with histopathological evaluation, is essential for accurate diagnosis and optimal prognosis. Conclusion: Although uncommon, appendiceal mucocele should be considered in patients with atypical appendicitis or a right iliac fossa mass. Recognizing its variable presentations and distinguishing it from carcinoid tumors are crucial to guide safe surgical management and prevent complications.