Pseudomyxoma Peritonei

PSEUDOMYXOMA PERITONAEI (syn. ascites gelatinosus), a distinctive rare disease of the abdominal cavity, characterized by the accumulation of mucus masses in the latter and their organization. P. p. is therefore not a tumor, but represents a change associated with the penetration of mucus into the abdominal cavity; the latter may be the result mainly of the following processes: mucus masses may enter the peritoneum from the vermiform appendix through perforations in it, from an intestinal diverticulum, from a ruptured ovarian cystadenoma, from remnants of the ductus omphalo-entericus, so-called enterocysts, etc. Being a foreign body, the mucus masses cause certain inflammatory phenomena on the part of the peritoneum, leading to the overgrowth and penetration (organization) of these masses, which results in a sharp limitation of the mobility of the intestinal loops, while at the same time giving the entire picture the appearance of a tumor. Many authors, however, interpret certain categories of P. p., especially those developing in connection with cystic tumors of the ovaries, as implantation metastases of epithelium producing mucus (E. Franenkel). Merkel also speaks of the implantation of intestinal epithelium in cases of P. p. that developed following the rupture of a hydropically dilated vermiform appendix. The question of the nature of P. p. cannot thus be considered settled. It is very probable that certain cases of P. p., especially those that occur after the rupture of ovarian cysts, are indeed associated with the secretion of mucus by the epithelium implanted on the peritoneum and therefore belong to neoplasms. In other cases, where the primary process has nothing to do with blastoma, for example in the case of rupture of the vermiform appendix, it is more correct to speak of chronic productive peritonitis caused by the presence of foreign substances (mucus, etc.) in the peritoneum. A picture similar to P. p. can be given by primary mucous carcinomas of the peritoneum. Treatment of P. p. is surgical.