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Management of an inguinal hernia in patients with pseudomyxoma peritonei
1Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, Washington, DC, USA.
Background:
Pseudomyxoma peritonei is a disease that results from a perforated mucinous neoplasm of the appendix so that mucinous ascites and mucin-producing tumor cells are widely disseminated in a characteristic pattern throughout the abdomen and pelvis. The intraabdominal mucus can accumulate in the inguinal canal and by physical examination be indistinguishable from the usual inguinal hernia.
Methods:
A database of patients with pseudomyxoma peritonei was used to identify patients who had an inguinal hernia prior to or at the time of cytoreductive surgery (CRS) and perioperative hyperthermic chemotherapy (HIPEC). At the time of CRS, care was taken in all patients to remove the peritoneal lining of the inguinal canal. Patients who had the inguinal hernia repaired prior to definitive treatment with CRS and HIPEC had all tissue and mesh associated with prior herniorrhaphy resected.
Results:
In 178 pseudomyxoma peritonei patients, 17 had a new onset or previously repaired inguinal hernia that required extraction of mucus and mucinous tumor from the hernia site. No repair of the open inguinal canal was attempted at the time of CRS. No recurrent inguinal hernias were recorded and no patients required an inguinal incision at a later time to resect progressive disease within the inguinal canal.
Conclusions:
Inguinal hernias caused by mucinous ascites and tumor were definitively treated by cytoreductive surgery plus HIPEC. Extraction of tumor and peritoneum from the inguinal canal facilitates fibrous closure of the hernia defect so that hernia recurrence was not observed.
Insights
Pseudomyxoma peritonei can cause inguinal hernias that mimic typical hernias. Cytoreductive surgery plus HIPEC effectively treated these hernias, with no recurrence observed after tumor extraction.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Imaging
Background:
- Pseudomyxoma peritonei arises from perforated appendiceal mucinous neoplasms, leading to widespread mucinous ascites and tumor cells.
- Intraabdominal mucus accumulation can present as inguinal hernias, clinically indistinguishable from common inguinal hernias.
Purpose of the Study:
- To evaluate the management and outcomes of inguinal hernias associated with pseudomyxoma peritonei.
- To assess the efficacy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in treating these specific inguinal hernias.
Main Methods:
- A retrospective review of pseudomyxoma peritonei patients who had inguinal hernias at the time of CRS and HIPEC.
- Inclusion of patients with prior inguinal hernia repair, involving resection of associated tissue and mesh.
- Peritoneal lining removal from the inguinal canal during CRS, without immediate hernia repair.
Main Results:
- Out of 178 pseudomyxoma peritonei patients, 17 presented with inguinal hernias requiring mucus and tumor extraction.
- No inguinal hernia repairs were performed during CRS.
- No recurrent inguinal hernias or subsequent surgeries for disease progression in the inguinal canal were recorded.
Conclusions:
- Inguinal hernias secondary to pseudomyxoma peritonei are definitively managed with CRS and HIPEC.
- Complete tumor and peritoneum extraction from the inguinal canal promotes spontaneous fibrous closure, preventing hernia recurrence.
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