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A New Etiology for the Abdominal Compartment Syndrome: Pseudomyxoma Peritonei.

Sabbagh C, Vaillandet C, Tuech JJ, Regimbeau JM - Case Rep Gastroenterol (2015)

Bottom Line: The progression of the disease results in obstruction and cutaneous leak.The patient was still alive 1 year after the procedure without any recurrence.In conclusion, acute abdominal pain and respiratory failure in patients with peritoneal PMP should lead to the measurement of the abdominal pressure but are not a contra indication for curative treatment of PMP.

View Article: PubMed Central - PubMed

Affiliation: Department of Digestive and Metabolic Surgery, Amiens University Hospital, University of Picardie Jules Verne, Amiens, France.

ABSTRACT
Pseudomyxoma peritonei (PMP) is a rare diagnosis with an incidence of 1-2 per million. Most cases originate from an appendix which ruptures and releases mucin into the peritoneal cavity. The progression of the disease results in obstruction and cutaneous leak. Abdominal compartment syndrome is an uncommon complication of peritoneal pseudomyxoma. In the present article, we report the case of a patient with PMP and abdominal compartment syndrome. A laparotomy to decrease the abdominal pressure was performed. Three months later, a peritonectomy with hyperthermic intraperitoneal chemotherapy was performed. The patient was still alive 1 year after the procedure without any recurrence. In conclusion, acute abdominal pain and respiratory failure in patients with peritoneal PMP should lead to the measurement of the abdominal pressure but are not a contra indication for curative treatment of PMP.

No MeSH data available.


Related in: MedlinePlus

a Preoperative view of the abdomen showing an abdominal distension due to the intra-abdominal mucin. b Horizontal view of the preoperative CT scan. * Mucin is making a scalloping aspect on the liver (black arrow). c Horizontal view of preoperative CT scan. There is mucin that is responsible of the abdominal compartment syndrome and a compression of the intra-abdominal organs at the mesentery. * Mucin (black arrow). % Compression of the intra-abdominal organs (disrupted black arrow). d Peroperative view. The omentum has been removed. * Omental cake (black arrow). e Abdomen at the end of the first procedure. The mucin has been removed. f CT scan, 1 year after the HIPEC procedure.
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Figure 1: a Preoperative view of the abdomen showing an abdominal distension due to the intra-abdominal mucin. b Horizontal view of the preoperative CT scan. * Mucin is making a scalloping aspect on the liver (black arrow). c Horizontal view of preoperative CT scan. There is mucin that is responsible of the abdominal compartment syndrome and a compression of the intra-abdominal organs at the mesentery. * Mucin (black arrow). % Compression of the intra-abdominal organs (disrupted black arrow). d Peroperative view. The omentum has been removed. * Omental cake (black arrow). e Abdomen at the end of the first procedure. The mucin has been removed. f CT scan, 1 year after the HIPEC procedure.

Mentions: The patient was a 55-year-old woman admitted to the emergencies for periumbilical abdominal pain. In her past medical history, a PMP on abdominal distension had recently been discovered without any surgical procedure. At the examination, the patient presented with acute dyspnea for 24 h. It quickly developed into acute respiratory distress that needed an orotracheal intubation. The blood gases showed hypoxemia (60 mm Hg) and hypercapnia (45 mm Hg). The chest abdominal CT scan showed that the mucin had increased compared to the former CT scan. The abdominal compartment syndrome suspected on these clinical and paraclinical data was confirmed by the measurement of the intravesical pressure in the supine position (30 mm Hg). A punction under ultrasound control was performed on the abdominal midline but failed due to the consistency of the mucin. A laparotomy to decrease the abdominal pressure was performed. The operative procedure included an omphalectomy, an omentectomy and an appendicectomy. This operation treated the abdominal compartment syndrome (fig. 1). Three months after surgery, a peritonectomy with hyperthermic intraperitoneal chemotherapy (HIPEC) was performed. The peritoneal cancer index score was 30. A complete peritonectomy (CC0) was performed; no other organ resection was necessary. The operative time was 600 min; chemotherapy agent was mitomycin 15 mg/m2 at 43°C for 30 min. There was no postoperative complication. The patient is still alive 1 year after the procedure without any recurrence (fig. 1).


A New Etiology for the Abdominal Compartment Syndrome: Pseudomyxoma Peritonei.

Sabbagh C, Vaillandet C, Tuech JJ, Regimbeau JM - Case Rep Gastroenterol (2015)

a Preoperative view of the abdomen showing an abdominal distension due to the intra-abdominal mucin. b Horizontal view of the preoperative CT scan. * Mucin is making a scalloping aspect on the liver (black arrow). c Horizontal view of preoperative CT scan. There is mucin that is responsible of the abdominal compartment syndrome and a compression of the intra-abdominal organs at the mesentery. * Mucin (black arrow). % Compression of the intra-abdominal organs (disrupted black arrow). d Peroperative view. The omentum has been removed. * Omental cake (black arrow). e Abdomen at the end of the first procedure. The mucin has been removed. f CT scan, 1 year after the HIPEC procedure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608611&req=5

Figure 1: a Preoperative view of the abdomen showing an abdominal distension due to the intra-abdominal mucin. b Horizontal view of the preoperative CT scan. * Mucin is making a scalloping aspect on the liver (black arrow). c Horizontal view of preoperative CT scan. There is mucin that is responsible of the abdominal compartment syndrome and a compression of the intra-abdominal organs at the mesentery. * Mucin (black arrow). % Compression of the intra-abdominal organs (disrupted black arrow). d Peroperative view. The omentum has been removed. * Omental cake (black arrow). e Abdomen at the end of the first procedure. The mucin has been removed. f CT scan, 1 year after the HIPEC procedure.
Mentions: The patient was a 55-year-old woman admitted to the emergencies for periumbilical abdominal pain. In her past medical history, a PMP on abdominal distension had recently been discovered without any surgical procedure. At the examination, the patient presented with acute dyspnea for 24 h. It quickly developed into acute respiratory distress that needed an orotracheal intubation. The blood gases showed hypoxemia (60 mm Hg) and hypercapnia (45 mm Hg). The chest abdominal CT scan showed that the mucin had increased compared to the former CT scan. The abdominal compartment syndrome suspected on these clinical and paraclinical data was confirmed by the measurement of the intravesical pressure in the supine position (30 mm Hg). A punction under ultrasound control was performed on the abdominal midline but failed due to the consistency of the mucin. A laparotomy to decrease the abdominal pressure was performed. The operative procedure included an omphalectomy, an omentectomy and an appendicectomy. This operation treated the abdominal compartment syndrome (fig. 1). Three months after surgery, a peritonectomy with hyperthermic intraperitoneal chemotherapy (HIPEC) was performed. The peritoneal cancer index score was 30. A complete peritonectomy (CC0) was performed; no other organ resection was necessary. The operative time was 600 min; chemotherapy agent was mitomycin 15 mg/m2 at 43°C for 30 min. There was no postoperative complication. The patient is still alive 1 year after the procedure without any recurrence (fig. 1).

Bottom Line: The progression of the disease results in obstruction and cutaneous leak.The patient was still alive 1 year after the procedure without any recurrence.In conclusion, acute abdominal pain and respiratory failure in patients with peritoneal PMP should lead to the measurement of the abdominal pressure but are not a contra indication for curative treatment of PMP.

View Article: PubMed Central - PubMed

Affiliation: Department of Digestive and Metabolic Surgery, Amiens University Hospital, University of Picardie Jules Verne, Amiens, France.

ABSTRACT
Pseudomyxoma peritonei (PMP) is a rare diagnosis with an incidence of 1-2 per million. Most cases originate from an appendix which ruptures and releases mucin into the peritoneal cavity. The progression of the disease results in obstruction and cutaneous leak. Abdominal compartment syndrome is an uncommon complication of peritoneal pseudomyxoma. In the present article, we report the case of a patient with PMP and abdominal compartment syndrome. A laparotomy to decrease the abdominal pressure was performed. Three months later, a peritonectomy with hyperthermic intraperitoneal chemotherapy was performed. The patient was still alive 1 year after the procedure without any recurrence. In conclusion, acute abdominal pain and respiratory failure in patients with peritoneal PMP should lead to the measurement of the abdominal pressure but are not a contra indication for curative treatment of PMP.

No MeSH data available.


Related in: MedlinePlus