We report a case of patient with end-stage renal disease (ESRD), receiving peritoneal dialysis, who showed ultrafiltration failure caused by rare pseudomixoma peritonei.
A caucasian fifty-years-old woman underwent peritoneal dialysis because of ESRD in renal hypoplasia.
After three years, she had difficult and incomplete discharge due to the presence of mucous material and fibrinoid else in the effluent.
The abdominal CT scan detected, in internal iliac artery right pelvis region, a lightly hyperdense alteration (25UH) compared to the remaining intraperitoneal liquid, with maximum diameter of 9x10 cm, apparently encapsulated , to report in the first hypothesis as a lot of fluid collection. ( Figure 1 ). Clinical suspect was for a ovarian tumor.
Major tumor markers were negative, except CEA ( 106.2 ng./ml, NV <5).
A trans-vaginal ultrasound exam detected: -in the right annex , the presence of swelling complex irregular margins with mixed echogenicity 12x9.7 cm, - in the left annex, solid neoplasm 6.5x3.7 cm. hyperchoic central located.
A diagnostic laparoscopy was performed and histological examination of mucinous sample detected pseudomyxoma peritoneal with small fragments of mucinous borderline tumor.
The patient underwent a mini-laparotomy with removal of material mucinous, intra-abdominal hysterectomy with bilateral salpingo-oophorectomy, appendectomy , pelvic peritonectomy, total omentectomy , gastrocolic total removal epiplon sigma , selective bilateral obturator lymph node dissection .
Five years later abdomen is negative for intra peritoneal liquid and tumors.
Pseudomyxoma peritonei represents a rare neoplastic condiction characterized by the collection of copious amounts of mucoid intraperitoneal fluid with mucin-secreting tumor implants spreading extensively along the peritoneal surface. It occurs more frequently in females than males.
The most common tumor origin of pseudomixoma peritonei is a mucinous tumor of the appendix. Other sites include the ovary, pancreas, and intestine.
