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Perforated mucocele of the appendix in the left upper quadrant: A challenging anatomy and an improvised surgical technique

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 anothe...

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Autores principales: Alhassan, Basmah Faris, Alharbi, Abdullah Saji, Omar, Walid Mokhtar, Zayed, Mohammed Ayesh, Abdulla, Maha, Bin Traiki, Thamer Abdulla
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598601/
https://www.ncbi.nlm.nih.gov/pubmed/31247520
http://dx.doi.org/10.1016/j.ijscr.2019.05.020
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author Alhassan, Basmah Faris
Alharbi, Abdullah Saji
Omar, Walid Mokhtar
Zayed, Mohammed Ayesh
Abdulla, Maha
Bin Traiki, Thamer Abdulla
author_facet Alhassan, Basmah Faris
Alharbi, Abdullah Saji
Omar, Walid Mokhtar
Zayed, Mohammed Ayesh
Abdulla, Maha
Bin Traiki, Thamer Abdulla
author_sort Alhassan, Basmah Faris
collection PubMed
description 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.
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spelling pubmed-65986012019-07-11 Perforated mucocele of the appendix in the left upper quadrant: A challenging anatomy and an improvised surgical technique Alhassan, Basmah Faris Alharbi, Abdullah Saji Omar, Walid Mokhtar Zayed, Mohammed Ayesh Abdulla, Maha Bin Traiki, Thamer Abdulla Int J Surg Case Rep Article 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. Elsevier 2019-05-11 /pmc/articles/PMC6598601/ /pubmed/31247520 http://dx.doi.org/10.1016/j.ijscr.2019.05.020 Text en © 2019 The Author(s) http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Alhassan, Basmah Faris
Alharbi, Abdullah Saji
Omar, Walid Mokhtar
Zayed, Mohammed Ayesh
Abdulla, Maha
Bin Traiki, Thamer Abdulla
Perforated mucocele of the appendix in the left upper quadrant: A challenging anatomy and an improvised surgical technique
title Perforated mucocele of the appendix in the left upper quadrant: A challenging anatomy and an improvised surgical technique
title_full Perforated mucocele of the appendix in the left upper quadrant: A challenging anatomy and an improvised surgical technique
title_fullStr Perforated mucocele of the appendix in the left upper quadrant: A challenging anatomy and an improvised surgical technique
title_full_unstemmed Perforated mucocele of the appendix in the left upper quadrant: A challenging anatomy and an improvised surgical technique
title_short Perforated mucocele of the appendix in the left upper quadrant: A challenging anatomy and an improvised surgical technique
title_sort perforated mucocele of the appendix in the left upper quadrant: a challenging anatomy and an improvised surgical technique
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598601/
https://www.ncbi.nlm.nih.gov/pubmed/31247520
http://dx.doi.org/10.1016/j.ijscr.2019.05.020
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