Aby Hadeer R, Ghattas S, Farhat H, Maalouf H, Bitar JE, Ayash D, Mohtar F, Elias B, Wakim R. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendiceal mucocele tumors: Five case reports and review of literature. World J Clin Cases 2026; 14(6): 117655 [DOI: 10.12998/wjcc.v14.i6.117655]
Corresponding Author of This Article
Ribal Aby Hadeer, MD, Department of General Surgery, University of Balamand, El Koura, Beirut 0000, Lebanon. ribal.abyhadeer@std.balamand.edu.lb
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Surgery
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 26, 2026 (publication date) through Feb 13, 2026
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World Journal of Clinical Cases
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2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Aby Hadeer R, Ghattas S, Farhat H, Maalouf H, Bitar JE, Ayash D, Mohtar F, Elias B, Wakim R. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendiceal mucocele tumors: Five case reports and review of literature. World J Clin Cases 2026; 14(6): 117655 [DOI: 10.12998/wjcc.v14.i6.117655]
World J Clin Cases. Feb 26, 2026; 14(6): 117655 Published online Feb 26, 2026. doi: 10.12998/wjcc.v14.i6.117655
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendiceal mucocele tumors: Five case reports and review of literature
Ribal Aby Hadeer, Souad Ghattas, Hadi Farhat, Hani Maalouf, Jad El Bitar, Dany Ayash, Faten Mohtar, Bachir Elias, Raja Wakim
Ribal Aby Hadeer, Souad Ghattas, Hadi Farhat, Hani Maalouf, Jad El Bitar, Dany Ayash, Faten Mohtar, Bachir Elias, Department of General Surgery, University of Balamand, Beirut 0000, Lebanon
Bachir Elias, Department of General Surgery, Middle East Institute of Health - University Hospital, Beirut 0000, Lebanon
Raja Wakim, Department of General Surgery, Mount Lebanon Hospital University Medical Center, Beirut 0000, Lebanon
Author contributions: Aby Hadeer R, Ghattas S, Farhat H and Maalouf H conceived and designed the study; Ghattas S, Ayash D and Mohtar F conducted the literature review and drafted the manuscript; El Bitar J collected the clinical data and assisted in manuscript drafting; Farhat H and Maalouf H contributed to data interpretation and critical revision of the manuscript; Elias B and Wakim R supervised the study, validated the data, and oversaw project administration. All authors critically reviewed the manuscript and approved the final version for submission.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ribal Aby Hadeer, MD, Department of General Surgery, University of Balamand, El Koura, Beirut 0000, Lebanon. ribal.abyhadeer@std.balamand.edu.lb
Received: December 24, 2025 Revised: January 20, 2026 Accepted: February 4, 2026 Published online: February 26, 2026 Processing time: 62 Days and 7.3 Hours
Abstract
BACKGROUND
Appendiceal mucocele with pseudomyxoma peritonei (PMP) is a rare entity that often presents late and requires specialized management. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has become the standard of care, yet real-world surgical experiences from diverse institutions remain limited. This case series highlights five patients presenting with appendiceal mucoceles complicated by PMP, emphasizing diagnostic challenges, operative strategies, and postoperative outcomes.
CASE SUMMARY
We report five patients (aged 45-75 years) who presented with symptoms ranging from abdominal distension and umbilical nodules to incidental imaging findings. All patients underwent a comprehensive diagnostic evaluation, including laboratory testing, tumor markers, and advanced imaging. Intraoperative findings revealed mucinous dissemination consistent with PMP. CRS was performed in all cases, with the extent determined by disease burden, followed by HIPEC using mitomycin C or oxaliplatin-based regimens. Pathology demonstrated low-grade or ruptured mucinous neoplasms as the primary etiology. Postoperative recovery was generally favorable, and although three patients developed recurrence requiring repeat CRS, all achieved meaningful disease control. These cases illustrate PMP’s chronic nature and the importance of multidisciplinary management.
CONCLUSION
CRS with HIPEC remains the most effective strategy for managing appendiceal mucocele-associated PMP.
Core Tip: Appendiceal mucoceles complicated by pseudomyxoma peritonei are uncommon and often present with nonspecific symptoms that delay diagnosis. Optimal management requires cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy. This five-patient case series highlights diverse presentations, imaging findings, operative strategies, and recurrence patterns. Our experience underscores the importance of early recognition, complete cytoreduction, individualized hyperthermic intraperitoneal chemotherapy protocols, and long-term surveillance to manage the chronic nature of pseudomyxoma peritonei effectively.
