Severe Erosive Esophagitis Secondary to Gastric Outlet Obstruction Related to Pseudomyxoma Peritonei

Abstract

Pseudomyxoma peritonei (PMP) is a rare clinical condition characterized by a mucin-producing tumor. PMP tumor cells migrate to abdominal and pelvic sites, eventually enveloping intra-abdominal organs and compressing the gastrointestinal tract. Patients with PMP are often asymptomatic in early stages of the disease, but in later stages develop symptoms including abdominal pain, acute abdomen, increased abdominal girth, vomiting, and bowel obstruction. Nonspecific symptoms combined with a relatively modest accuracy of imaging modalities frequently lead to delay in PMP diagnosis and treatment, thereby increasing morbidity. We present a case demonstrating severe erosive esophagitis as a result of PMP-associated gastric antrum compression.

Figure 1.

Endoscopic view of the distal esophagus and gastroesophageal junction revealing severe circumferential erosive esophagitis.

Figure 2.

Endoscopic view of the gastric antrum showing nondistensible mucosa in the prepyloric region.

Figure 3.

Contrast abdominal computed tomography images, (A) axial view, (B) coronal view, revealing classic “scalloping” of the liver in the setting of gelatinous ascites.

Figure 4.

Biopsy of a peritoneal specimen at (A) hematoxylin and eosin stain, 100× magnification and (B) hematoxylin and eosin stain, 400× magnification showing tumor cells with prominent single cytoplasmic mucin vesicle and eccentrically placed hyperchromatic nuclei.