A 60-year-old woman presents with progressive abdominal distension and a gelatinous feel to the abdomen on examination. CT shows scalloping of the liver surface and loculated mucinous fluid throughout the peritoneal cavity without a definite ovarian mass. Histology from a prior appendicectomy showed a low-grade mucinous epithelial proliferation confined to the wall. What is the most appropriate definitive treatment strategy?

• A Repeated debulking laparotomies whenever symptoms recur
• B Systemic chemotherapy with oxaliplatin and fluorouracil alone
• C Total abdominal hysterectomy with bilateral salpingo-oophorectomy only
• D Complete cytoreductive surgery combined with heated intraperitoneal chemotherapy ✓

Explanation

This is pseudomyxoma peritonei, arising most commonly from a low-grade appendiceal mucinous neoplasm. Mucinous epithelium disseminates over peritoneal surfaces and produces progressive gelatinous ascites. The established curative-intent approach is complete cytoreduction of all visible peritoneal disease combined with heated intraperitoneal chemotherapy (HIPEC) performed at the same sitting. Repeated debulking alone leads to progressive entrapment of bowel and eventual death from nutritional failure, while systemic chemotherapy has limited penetration into mucinous deposits.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.