Diagnosis and treatment of pseudomyxoma peritonei in accidental discovery: a report of 8 cases / 国际外科学杂志

Objective To investigate the diagnosis and treatment of pseudomyxoma peritonei (PMP) and provide a reference for diagnosis and treatment of PMP.Methods The clinical features,laboratory examinations,treatment and outcomes of 8 PMP misdiagnosed cases were analyzed with recent relevant reference.Results Ultrasonography,CT,peritoneal cytological examination,tumor markers results are helpful for diagnosis of PMP.PMP will be confirmed and classified by pathological examination after operation.Complete cytoreductive surgery (CRS)or major debulking surgery (MDS) of the tumor combined intraperitoneal chemotherapy and systemic chemotherapy,eight patients in seven cases survived 4-71 month range,one patient died of respiratory failure of pulmonary infection after the third operation.Conclusions Ultrasonography,CT,peritoneal cytological examination,tumor markers tests help avoid misdiagnosis of PMP before operations.Intraoperative findings follow after PMP,CRS or MDS should be executed in the operation or the next time.Intraperitoneal chemotherapy and conventional chemotherapy can improve survival in patients with PMP and prolong their survival time.

Pseudomixoma peritoneal por tumor del apéndice cecal / Peritoneal pseudomyxoma due to cecal appendix tumor

Objetivo: presentar un caso de una patología de muy baja incidencia y realizar una revisión bibliográfica de la misma. Paciente y método: paciente femenina de 87 años de edad que ingresa por guardia por cuadro compatible con hernia inguinal atascada, por lo que se decide cirugía de urgencia. En el acto operatorio se identifica un saco herniario de paredes engrosadas, con contenido intestinal con buena vitalidad, sin signos de necrosis, identificando además abundante secreción mucinosa en el saco herniario y proveniente de la cavidad abdominal. Se decide terminar con la hernioplastia y realizar estudios complementarios diferidos. Luego de los mismos, el comité de tumores decide la realización de nueva cirugía (hemicolectomía derecha con ileotransverso anastomosis por tumor mucinoso de apéndice), durante la cual se constata ascitis gelatinosa. La paciente evoluciona favorablemente y es dada de alta a las 72 horas del post operatorio. La anatomía patológica informa adenocarcinoma mucinoso de apéndice bien diferenciado. Discusión: el Pseudomixoma Peritoneal es una entidad muy poco frecuente, que hace referencia a la diseminación peritoneal de un tumor cuyas células producen gran cantidad de mucina. La supervivencia global de los pacientes es de aproximadamente 75 y 68% durante 5 y 10 años. La clasificación más aceptada es la de Ronnet. Tradicionalmente, el tratamiento ha sido la cirugía de citoreducción, aunque hay autores que proponen procedimientos más agresivos como la peritonectomía más quimioterapia hipertérmica intraoperatoria.

Objective: to present a case of a very low incidence disease and a bibliographic review of it. Patient and method: 87 years old female patient with a compatible history and physical exam for a stuck inguinal hernia, for which we decided to perform emergency surgery. During the surgical procedure, we find a thickened hernia sac, with mucus in it and in the abdominal cavity. The small intestine was vital and not complicated. We finished the hernioplasty, and decided to perform complementary ambulatory studies to the patient. After having them done, we decided, in an interdisciplinary committee, to perform an exploratory surgery, (hemicolectomy with ileum transverse anastomosis for an appendix tumor), during which gelatinous ascites was noticed. The patient evolve favorably and was discharged 72 hours post operation. The surgical biopsy informed an appendix mucinous adenocarcinoma well differentiated. Discussion: the peritoneal pseudomyxoma is a very infrequent entity. The overall survival is 75 and 68% for 5 and 10 years, respectively. Ronnet had published the most accepted histological classification. The accepted treatment is the cytoreductive surgery, although some authors proposed a more aggressive treatment such peritonectomy with hyerthermic intraperitoneal chemotherapy.

Diagnostic Value of Multi-slice Spiral in Pseudomyxoma Peritonei / 实用放射学杂志

Objective To investigate the MSCT characteristics of peritoneal pseudomyxoma. Methods CT findings of peritoneal pseudomyxoma proved by surgery and pathology in 11 cases were retrospectively analyzed. Results On MSCT,the peritoneal pseud-omyxomas were irregular intraperitoneal cystic-solid masses, the CT attenuation was 18.5 ～ 27.6 HU, there were scallop-like, wavy and nodule-like indentations on the liver and/or spleen surface,large amount of mucinous ascites within abdominal, pelvic an-domentum cavity , thickening of peritoneum. On post-contrast administration , mild enhancement of peritoneum,cystic wall and omentum could be revealed. Conclusion MSCT examination has important value in diagnosis and differential diagnosis of peritoneal pseudomyxomas

Clinical Analysis of Appendiceal Mucoceles / 中国医师杂志

Objective To investigate the diagnostic and treatment methods of appendiceal mucoceles and peritoneal pseudomyxoma. Methods Thirteen cases of appendiceal mucoceles were enrolled in this study. Six cases underwent appendectomy, two cases ileocecal resection, two cases right colectomy, and two cases appendectomy in emergency followed by right colectomy because their postoperative pathological diagnosis was appendiceal muco-cystadenocarcinoma. Ruptured appendiceal mucocele and peritoneal pseudomyxoma were found during operation in one case, then right colectomy was performed, ascites was removed and abdominal cavity was washed with normal saline and 5-Fu solution. Systemic chemotherapy was given to this patient after operation. Results Operation was successful in all the patients. Except one case not followed up, the other patients remained free of disease after operation. Conclusion Appendiceal mucoceles is uncommon. The patients should be suspected suffering from this disease when chief complaints are right lower abdominal pain and mass. B-type ultrasonography and other necessary digestive image examinations are economical and inexpensive diagnostic method of appendiceal mucoceles. It is necessary to explore the whole abdominal cavity carefully when this disease is suspected during operation.