Peritoneal pseudomyxoma in a patient affected by appendicular mucocele: a case report

Abstract

Pseudomyxoma peritonei (PMP) is an uncommon clinical condition, characterized by mucinous ascites, generally associated with a rupture of an epithelial neoplasm of the appendix. Some authors also use the term PMP to indicate mucinous dissemination after rupture of mucin-producing tumors of other sites (i.e. colon, ovary). Clinical presentation is variable and depends on the progressive accumulation of mucinous ascites (obstructive symptoms); weight loss, elevated Ca 19.9 and Ca 125 levels can be present. Here, we report a case of a 58-year-old patient with a history of appendicular mucocele and HCV-related hepatopathy, who accessed to the emergency department of our institute for the onset of epigastric pain associated with food vomiting for 5 days. Blood tests demonstrated a mild leukocytosis, a mild anemia (Hb 12.8 g/dL), and increased transaminases and cholestasis indices. A contrast-enhanced CT (CECT) scan was performed: a peritoneal cavity filled with a neoformation with lobulated margins and over-water density leading to multiple incisions of the hepatic and splenic parenchyma was documented. Appendix had an increased caliber (4 cm) with coprolite near its origin. Hence, the suspicion of PMP was raised and later confirmed on surgical exploration.