Gastrointestinal surgery: appendiceal mucocele: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: appendiceal mucocele

Sample item

During laparoscopy for a right iliac fossa mass, a surgeon finds a 4 cm distended, mucus-filled appendix with an intact wall and no free mucin in the peritoneal cavity. Which principle of surgical management is most important?

ALeave it and repeat imaging in six monthsBIncise it and marsupialise to the skinCAspirate the mucin first to decompress itDRemove it intact, avoiding rupture or spillage

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Remove it intact, avoiding rupture or spillage

A mucin-filled appendix may harbour a mucinous neoplasm. Rupture seeds the peritoneum with mucin-secreting cells and leads to pseudomyxoma peritonei, so the specimen must be removed intact and retrieved in a bag without grasping the wall.

Option by option

A. Leave it and repeat imaging in six months
Observation does not remove a lesion that may be neoplastic and may rupture.
B. Incise it and marsupialise to the skin
Marsupialisation leaves a potentially neoplastic lesion in place and risks spillage.
C. Aspirate the mucin first to decompress it
Aspiration or puncture releases mucin and cells into the peritoneal cavity, which is exactly what must be avoided.
D. Remove it intact, avoiding rupture or spillage (correct)
Correct. Avoiding rupture prevents peritoneal seeding by neoplastic mucinous epithelium.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Remove it intact, avoiding rupture or spillage. A mucin-filled appendix may harbour a mucinous neoplasm.

Why is "Leave it and repeat imaging in six months" not the answer?

Observation does not remove a lesion that may be neoplastic and may rupture.

Why is "Incise it and marsupialise to the skin" not the answer?

Marsupialisation leaves a potentially neoplastic lesion in place and risks spillage.

Why is "Aspirate the mucin first to decompress it" not the answer?

Aspiration or puncture releases mucin and cells into the peritoneal cavity, which is exactly what must be avoided.

What concept does this question test?

It tests Gastrointestinal surgery: appendiceal mucocele in General Surgery. Rupture seeds the peritoneum with mucin-secreting cells and leads to pseudomyxoma peritonei, so the specimen must be removed intact and retrieved in a bag without grasping the wall.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: appendiceal mucocele?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.