At laparoscopy for a cystic right iliac fossa mass, a 55-year-old woman is found to have a markedly distended, tense appendix filled with gelatinous material. Frozen section suggests a low-grade appendiceal mucinous neoplasm confined to the appendix with a free base. What is the single most important operative consideration?

• A Aspiration of the contents before delivery to reduce size
• B Placement of an intraperitoneal drain at the site of the mass
• C Routine right hemicolectomy in every case regardless of margin status
• D Avoidance of any rupture or spillage of mucin into the peritoneal cavity ✓

Explanation

Rupture of a mucinous appendiceal neoplasm seeds viable mucin-secreting epithelium throughout the peritoneal cavity, producing pseudomyxoma peritonei, a disease requiring cytoreductive surgery with heated intraperitoneal chemotherapy. The appendix should be delivered intact, often within a bag, and aspiration is avoided for this reason. Right hemicolectomy is added only for a positive base margin, nodal involvement, or high-grade histology, and a drain does nothing to prevent peritoneal seeding.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.