Perforated mucocele of the appendix in the left upper quadrant: A challenging anatomy and an improvised surgical technique
| Autor: | Basmah Faris Alhassan, Abdullah Alharbi, Thamer Bin Traiki, Walid Mokhtar Omar, Mohammed Ayesh Zayed, Maha Abdulla |
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| Rok vydání: | 2019 |
| Předmět: |
Malrotation
Perforation (oil well) Mucocele Article Colon resection 03 medical and health sciences 0302 clinical medicine Case report medicine Pseudomyxoma peritonei HIPEC business.industry Anatomy medicine.disease Appendix medicine.anatomical_structure Intestinal malrotation 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Surgery Presentation (obstetrics) business Complication Rare disease |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2019.05.020 |
| Popis: | Highlights • Pseudomyxoma peritonei (PMP) is a devastating consequence of perforated appendicular mucocele. It is considered a rare disease. • The presence of asymptomatic gut malrotation in adults can complicate the clinical picture of acute abdomen. ** (starting a new highlight point): Not considering possible anatomical variations initially during assessment could delay the diagnosis and managment. • The introduction of Cytoreductive Surgery/Heated Intraperitoneal Chemotherapy (CRS/HIPEC) improved the outcome of many patients with PMP. • Preserving part of the colon during challenging colorectal resection to allow a colo-rectal anastomosis offers a superior quality of life. Introduction Pseudomyxoma peritonei (PMP) is a feared complication of appendicular mucocele perforation. Although a rare disease, its major sequel mandates recognition and early intervention. Intestinal malrotation is mostly asymptomatic in adults. Its significance arises when it complicates another coinciding condition by confusing the presentation, leading to delay in diagnosis and treatment. PMP and incidental finding of gut malrotation in adults are two rare events, and the chance of both occurring in the same patient is very slim. This can complicate the clinical picture and lead to devastating outcomes. Presentation of the case We present a case of PMP in a patient with gut malrotation, managed with cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC). Discussion Management with CRS/HIPEC has been found to improve outcomes for patients with PMP. However, the extensive disease and abnormal anatomy of the patient in our report proposed unique intraoperative challenges. Preserving part of the colon was possible with an improvised surgical technique that we used which proved to be safe and effective. Conclusion Early recognition and consideration of uncommon but serious surgical conditions are essential for improved patient outcomes. To our knowledge, this is the first report in the English literature that describes the use of CRS/HIPEC for PMP in a case of intestinal malrotation. This improvised surgical technique was found to be safe and can provide a surgical solution for preserving part of the colon in selected patients. |
| Databáze: | OpenAIRE |
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