Gracilis Muscle Interposition with Anterior Pelvic Floor Repair: A Retrospective Analysis of Six Cases of Complex Perianal Fistula

Abstract

Background: Pseudomyxoma peritonei with disseminated peritoneal adenomucinosis is a rare, chronic, relapsing, diagnostically challenging and poorly understood disease characterized by mucinous ascites and peritoneal implants.Methods: All the patients diagnosed as pseudomyxoma peritoneii admitted to Amrita Institute of Medical Sciences were analysed retrospectively. A total of 17 patients were analysed with regard to sex, mode of presentation, management, histopathological analysis and further treatment. Patients with peritoneal implants that came positive for malignancy were excluded from the study.Results: 17 patients were studied; out of which, majority were females 64.7% (11), abdominal distension 52.9% (9) was the most common presentation, 52.9% (9) patients underwent cytoreductive that was thought to be incomplete, 47.05% (8) had complete cytoreductive surgery. In 94.11% ( 16), the origin of majority of the tumors were appendix with only case where the origin was from ovary and appendix was found to be normal. Histopathologically, 29.4% (5) was mucinous cystadenoma of appendix with DPAM, 41.2% (7) cystadenocarcinoma of the appendix, 29.4% (5) patients were diagnosed as mucinous neoplasm of appendix with uncertain malignant potential with disseminated peritoneal adenomucinosis (DPAM). Patients with malignant features in appendix were considered for adjuvant chemotherapy. Most of the patients were followed-up for a period ranging from 1 year to 7 years with a median of 3 years. Out of 17 patients, 5 patients developed features of recurrence but were managed conservatively without the need for surgery.Conclusion: Disseminated peritoneal adenomucinosis (DPAM) is a distinct clinical entity when peritoneal carcinomatosis is to be ruled out. Appendix is the most common origin of DPAM even in females. Abdominal distension is the commonest presentation. Surgical debulking is an ideal option even when complete cytoreductive surgery is not possible. Assessment of tumor histology is important in ruling out the peritoneal carcinoma. In DPAM, good long-term results can be obtained with only cytoreductive surgery.