Hernie inghinală - manifestare a pseudomixomului peritoneal

Abstract

Introducere. Pseudomixomul peritoneal (PMP) este o nosologie rară, caracterizată prin acumularea intraperitoneală de mucus produs de celule neoplazice de origine apendiculară. Semnele clinice fiind diverse, diagnosticul preoperator deseori este dificil. Material şi metodă. Descriem cazul clinic al unui pacient de 67 ani, internat la peste o lună de la herniotomie prezentând semne clinice de PMP. A fost efectuată citoreducerea chirurgicală, peritoneumectomie, apendiciectomie, omentectomie şi chimioterapie intraperitoneală perioperatorie. Rezultate. Pacientul a fost asimptomatic timp de 15 luni, când a decedat aparent în urma unui atac cardiac. Concluzie. În concluzie, în caz de prezenţă a lichidului gelatinos în timpul herniotomiei – pacientul trebuie investigat histologic şi tomografic pentru a confirma PMP.

Introduction. Pseudomyxoma peritonei (PMP) is rare being characterized by intraperitoneal accumulation of mucinous ascites produced by neoplastic cells, mostly originating from a perforated appendiceal adenoma. The clinical signs of the disease are variable, and preoperative diagnosis is often difficult. Material & methods. We describe the clinical case of a 67-year-old patient referred to our unit one month after a left inguinal hernia repair, presenting clinical signs compliant with PMP. Surgical cytoreduction, peritonectomy, appendectomy, and greater omentectomy with perioperative intraperitoneal chemotherapy were performed. Results. The patient was disease free for a 15 month period when he died apparently due to a cardiac event. Conclusion. We advocate that in all cases of gelatinous fluid in a hernia sac PMP must be suspected, thus histological investigation is mandatory as well as abdominal computed tomography (CT) in order to confirm the diagnosis.