# Torsion of Appendiceal Mucinous Neoplasm: A Rare Cause of Right Lower Quadrant Abdominal Pain

## TL;DR

A rare case of a twisted appendix tumor causing abdominal pain is described, emphasizing the importance of careful surgical handling to prevent complications.

## Contribution

This case report highlights the rare occurrence of torsion in an appendiceal mucinous neoplasm and its management challenges.

## Key findings

- A 64-year-old male presented with right lower quadrant pain due to a torsed appendiceal mucinous neoplasm.
- Surgical conversion from laparoscopy to laparotomy prevented mucocele rupture during tumor removal.
- The patient had a successful recovery with no recurrence at follow-up.

## Abstract

Appendiceal mucinous neoplasms are rare, and torsion of the appendix is exceptionally uncommon. Rupture of an appendiceal mucinous neoplasm can lead to pseudomyxoma peritonei, a condition with high morbidity. We present the case of a 64-year-old male patient with five days of right lower quadrant abdominal pain. Cross-sectional imaging of the abdomen and pelvis revealed a five-centimeter-long, tubular, ring-enhancing lesion, concerning for a mucocele. Intraoperatively, a 360-degree appendiceal torsion was identified, prompting conversion from laparoscopy to laparotomy to avoid mucocele rupture. Pathology confirmed a low-grade appendiceal mucinous neoplasm with negative margins. The patient recovered uneventfully and remained asymptomatic at follow-up. This case underscores the deceptive presentation of a torsed appendiceal mucocele and highlights important technical considerations for optimal operative management of this pathology.