Incidental diagnosis of pseudomyxoma peritonei by laparoscopy: a rare case from Syria

Abstract

Pseudomyxoma peritonei (PMP) is a rare malignancy of the abdomen, which is usually described as a gelatinous peritoneal fluid. A 33-year-old man came to the ER complaining of recurring abdominal pain with abdominal distention for the past 3 months. Abdominal ultrasound revealed moderate amount of turbulent ascitic fluid with septations, in addition to a mass with irregular margins consisting of liquid and cysts. Abdomen and pelvis computed tomography scan showed free abdominal fluid. A decision was made for abdominal diagnostic laparoscopy with biopsies from the peritoneum, mesenteries and the gelatinous fluid. We could not investigate all the abdominal cavities and appendix due to the presence of severe adhesions and tuberculosis suspension. The pathology report indicated PMP. The patient was referred to an oncologist for chemotherapy consultation. The diagnosis can be challenging, as the symptoms and signs vary from patient to another; most cases may be asymptomatic and discovered incidentally during laparoscopy.

Figure 1

Computed tomography scan of the abdomen and pelvis showed massive amount of free abdominal fluid and irregular margins of the liver.

Figure 2

Abdominal laparoscopy showed a huge amount of mucus gelatinous fluid.

Figure 3

Biopsies from (A) peritoneum and (B) omentum showed acellular mucin consistent with PMP. No mucinous, degenerative or tumor cells are seen.