Incidental Diagnosis of Pseudomyxoma Peritonei After Emergent Splenectomy

• Published in: The American surgeon 2023-04, Vol.89 (4), p.1115-1117
• Main Authors: Ferre, Alexandra C., Burstein, Matthew, El-Hayek, Kevin M.
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Pain - etiology; Adenocarcinoma; Adenocarcinoma, Mucinous - pathology; Aged; Appendiceal Neoplasms - diagnosis; Appendix; Ascites; Asymptomatic; Biopsy; Cancer; Cecum; Chemotherapy; Cholecystectomy; Computed tomography; Diagnosis; Dyspnea; Emergency medical care; Emergency medical services; Extravasation; Hematoma; Humans; Laparoscopy; Laparotomy; Male; Medical imaging; Medical prognosis; Metastasis; Omentum; Pain; Pathology; Patients; Peritoneal Neoplasms - diagnosis; Peritoneal Neoplasms - pathology; Peritoneal Neoplasms - surgery; Pseudomyxoma Peritonei - diagnosis; Pseudomyxoma Peritonei - pathology; Pseudomyxoma Peritonei - surgery; Spleen; Splenectomy; Splenectomy - adverse effects; Surgery; Tomography; Trauma; Tumors
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/0003134820954822

Pseudomyxoma peritonei (PMP) is a rare disease associated with mucinous ascites. Pseudomyxoma peritonei has a low incidence and is difficult to diagnose. Pseudomyxoma peritonei usually presents with vague abdominal pain after significant progression. Computed tomography imaging is the most common modality for diagnosis; however, diagnosis as a result of surgical intervention in cases of acute abdomen has become increasingly common. We present a unique case of a 66-year-old man who was incidentally diagnosed with PMP after undergoing an emergent splenectomy for presumed blunt trauma. The patient presented to the emergency room with abdominal pain, shortness of breath, and diaphoresis. Computed tomography imaging revealed a splenic hematoma with suspicion of extravasation and a moderate amount of free intraperitoneal fluid consistent with blood. The patient was taken to the operating room emergently for an emergent splenectomy where splenic laceration was noted, as were multiple areas of nodularity in the omentum and cecum. Histologic evaluation of these lesions led to the diagnosis of PMP. After recovery from his initial splenectomy, the patient underwent exploratory laparotomy, cytoreductive surgery, cholecystectomy, removal of appendiceal mucocele, and hyperthermic intraperitoneal chemotherapy without complication. Final pathology was consistent with PMP and primary mucinous appendiceal adenocarcinoma. This case highlights an unusual presentation of PMP for a patient who was undergoing surgery for presumed splenic trauma. Surgeons must maintain a high index of suspicion and should perform histological evaluation when such unexpected findings are encountered.