Peritoneal pseudomyxoma after incomplete appendectomy.

Abstract

A41-year-oldwomanwas referredbecauseof abdominalpain, reporting on an appendectomy 24 years ago. At that time, she developed a postoperative intra-abdominal abscess and was told that the tip of the appendix had been left in the abdomen. Seventeenyears later, aCT-scan showeda6cmcystic tumorat the caecum base (Figure 1A). The treatment was conservative. The abdominal CT-scan now showed a 15 cm large tumor (Figure 1B). A low-grade pseudomyxomaperitonei (PMP)with a Peritoneal Cancer Index (PCI) of 6/39 was diagnosed. A 59-year-old man presented with abdominal pain nine years after a laparoscopic appendectomy. He reported on an intra-abdominal abscess eight months postoperatively, requiring radiological drainage. A low-grade PMP (PCI 12) was diagnosed, andanappendix tip remnant identified (Figure 1C). A PMP can arise from an appendiceal tip remnant. A history of appendectomy does not exclude an appendiceal origin of PMP.