P-184 - Gelatinous peritoneal disease (service experience)

Abstract

Introduction: It is a rare disease. It is a pathological condition in which the peritoneal cavity fills with a viscous substance similar to gelatin. Ovarian and appendicular causes share almost all etiologies, but there are also peritoneal causes and gelatinous cryptogenetic diseases of the peritoneum. It is due to a borderline tumor, ie to the limit of benignity by its histological characteristics and the absence of metastases; And at the limit of malignancy by the rapidity and abundance of the mucoid substance, the peritoneal dissemination and the risk of recurrence. Methods: OBSERVATION We report a series of 10 patients operated in the service over a period of 5 years (2010-2015). These are documented cases (iconography and photographs per op) of gelatinous disease of the peritoneum secondary to the rupture of an ovarian mucinous cystadenoma or an appendicular mucocele. The mean age was 45 years with extremes ranging from 30 to 65 years, sex ratio 6 women and 4 men. The reason for consultation was an increase in volume of the abdomen associated with abdominal pain. Abdominal-pelvic ultrasound as well as CT scan showed an ascitic effusion of great abundance and compartmentalization. Intraoperative exploration had recovered a gelatinous ascites with ruptured ovarian tumor in 5 patients, a ruptured appendicular mucocele in 4 patients. In 1 case the association of the two is noted. Results: All patients underwent peritoneal cavity lavage, bilateral ovariectomy in 6 patients, appendectomy and omentectomy in all patients. The operative sequences were simple. The anatomopathological findings were in favor of a mucinous cystadenoma of the ovary and mucocele of the appendix with gelatinous ascites. Patients were referred to the oncology department. Conclusion: The treatment is mainly symptomatic and relies on the evacuation of the liquid. Since this act is very difficult to perform on the needle, a laparoscopy or laparotomy is usually performed. The natural course of the disease is characterized by recurrences. Ganglion and distant metastases are exceptional. The first surgery is performed to ablate the responsible tumor and to evacuate the gelatinous ascites, it is also the treatment of choice in the recurrences by using the proteolytic enzymes. Currently the effectiveness of chemotherapy is not clearly demonstrated. Some authors propose intraperitoneal chemotherapy that would be more effective. Radiation therapy is ineffective. Future prospects are based on the use of new, more appropriate proteolytic enzymes and also more effective chemotherapy. The prognosis is pejorative because the disease almost always evolves towards the fatal deadline.