UNASSIGNED: Leiomyomatosis peritonealis disseminata (LPD) is a non-metastatic, homologous, multicentric benign disorder characterized by small leiomyomas scattered over the peritoneum and omentum. It is a rare and benign disease with invasive potential. LPD mainly attacks women of childbearing age but has also been reported in post-menopausal women, men, and young children. Non-specific clinical and imaging findings of LPD lead to difficult diagnoses and treatment.
UNASSIGNED: This study reports the case of a patient with recurrent LPD with endometriosis after multiple myomectomies and hysterectomy, who presented recurrent abdominal pain with progressive exacerbation. Imaging examinations showed irregular shadows in the pelvic cavity and multiple nodular changes in the peritoneum, which were considered malignant lesions. A solid mass sized 10 cm × 9 cm × 10 cm in the inferior pelvis and nodules scattered over the surface of pelvic and abdominal organs and the peritoneum were detected during the surgery. The patient was treated with cytoreductive surgery (CRS), peritonectomy, ovarian ablation, and hyperthermic intraperitoneal chemotherapy (HIPEC). The surgery was challenging, and the intraoperative bleeding reached 900 ml. However, the patient recovered well and achieved a tumor-free survival of 13 months.
UNASSIGNED: It was concluded that a combination of CRS, ovarectomy, and HIPEC might be one of the therapeutic strategies for recurrent LPD.

Both pseudomyxoma peritonei and Morgagni hernias in adults are rare clinical conditions. A 70-year-old woman who was diagnosed with pseudomyxoma peritonei with Morgagni hernia underwent cytoreductive surgery and primary repair. Pseudomyxoma peritonei causes increased intra-abdominal pressure that may lead to acquired congenital diaphragmatic hernia when there is a local fragility in the diaphragmatic musculature. Parietal peritonectomy of the right diaphragmatic peritoneum can safely remove the hernia sac. The high rate of infections associated with cytoreductive surgery causes hesitation for concurrent mesh repair for Morgagni hernia. This is the first report of pseudomyxoma peritonei with Morgagni hernia. Cytoreductive surgery including parietal peritonectomy of the right diaphragmatic peritoneum plus primary repair of hernial defect was performed safely and successfully, which achieved positive short-term results for patients with pseudomyxoma peritonei-associated Morgagni hernia.

UNASSIGNED: We report a rare case of post-orgasmic pain associated with endometriosis of the left hypogastric nerve and posterior vaginal wall. It is not a typical symptom of dyspareunia and has not been frequently associated with endometriosis in previous reports.
METHODS: A 36-year-old woman presented with post-orgasmic pain exclusively at orgasm, but no dyspareunia during intercourse. She also reported bladder irritation and secondary dysmenorrhea.
UNASSIGNED: Physical examination revealed a small mass on the posterior vaginal wall and thickening of the left uterosacral ligament (USL) associated with severe pain. Pelvic magnetic resonance imaging (MRI) revealed endometrial tissue infiltration of the USL, hypogastric nerve tract, and posterior vaginal wall, consistent with endometriosis. Laparoscopic surgical excision was performed. Complete en bloc peritonectomy excision of the posterior pelvic compartment and complete removal of the lesions identified on MRI was performed. There were no postoperative complications and symptoms resolved completely. Histopathological examination revealed endometriosis.
CONCLUSIONS: Orgasm-associated pain is rarely associated with endometriosis of the hypogastric nerve. In most cases there is no obvious cause for this symptom in this type of dysorgasmia. The complete resolution of symptoms after removal of the endometriosis by peritonectomy of the posterior pelvic compartment and en bloc excision strongly suggests a causal relationship between endometriosis of the hypogastric nerve and the orgasmic pain and urinary symptoms observed in this case. Also, the effective surgical technique used to treat endometriosis.

BACKGROUND: Pseudomyxoma Peritonei (PMP) is a mucin producing cancer with appendix as primary site. Cytoreductive Surgery (CRS) combined with hyper-thermic intraperitoneal chemotherapy (HIPEC) is an established form of therapy known to prolong survival in patients with PMP and peritoneal carcinomatosis. Methods/patients In our case series, we present five cases of PMP with synchronous liver and peritoneal metastasis treated with CRS and HIPEC. It is a very rare condition which needs more research to be able to comment on overall survival.
RESULTS: However, in our study, we found lower age, female gender and complete cytoreduction in surgery to be favourable predictors for improved morbidity.
CONCLUSIONS: In our experience, CRS/HIPEC seem to be feasible for patients with PMP with synchronous liver and peritoneal metastasis.

UNASSIGNED: Endometrial cancer may disseminate through lymphatic channels to pelvic and retroperitoneal lymph nodes, through the bloodstream to the lungs, or through the peritoneal space to peritoneal surfaces. However, not all endometrial cancers involve all 3 sites for metastatic disease.
METHODS: A patient with large volume of symptomatic recurrence of peritoneal metastases from endometrial cancer was subjected to additional surgery and both regional and systemic chemotherapy. All aspects of her disease and its treatment were studied.
UNASSIGNED: The primary malignancy was treated by a laparoscopic hysterectomy and bilateral salpingo-oophorectomy followed by intravaginal radiation. Large volume recurrent disease limited to the abdomen and pelvis was treated by complete cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC). After recovery from surgery, systemic chemotherapy with cisplatin and paclitaxel was administered. The patient is now 25 months following treatment for recurrent cancer and free of disease.
CONCLUSIONS: The possibility of complete resection of recurrent endometrial cancer combined with HIPEC, EPIC and systemic chemotherapy is a treatment option for selected patients.

BACKGROUND: This report presents the rare case of a patient with complete bowel ischaemia following parastomal hernia, leading to total bowel resection, with consideration of post-operative complications and wound management.
METHODS: A 59 year old female was found to have complete small bowel ischaemia on exploratory laparatomy, on a background of recurrent appendiceal adenomucinosis, for which she had received previous peritonectomy, cholecystectomy, total colectomy, and partial small bowel resection. The patient was managed with total enterectomy and post-operative total parenteral nutrition.
CONCLUSIONS: Total enterectomy represents a significant challenge in the postperitonectomy setting, including consideration of wound management with the empty abdomen, and the potential of small bowel transplant in management.
CONCLUSIONS: Resection of the small bowel following total small bowel ischaemia is feasible in the post-peritonectomy setting, given appropriate post-operative care and wound management. However, long-term survival remains challenging, especially without small bowel transplant.

BACKGROUND: Colorectal cancer can disseminate malignant cells to the peritoneal surfaces which over time progress to peritoneal metastases. Management of this type of metastatic disease has been approached using a combined treatment that consists of cytoreductive surgery and perioperative chemotherapy. To optimize these treatments a more effective chemotherapy that is used as planned part of the surgical procedure is required.
UNASSIGNED: Pharmacologic studies to initiate a new perioperative chemotherapy treatment were modeled after the successful systemic treatments of metastatic colorectal cancer referred to as FOLFOX. A management plan that included all of the essential features of successful systemic chemotherapy was formulated. Pharmacokinetic studies of 5-fluorouracil given both intravenously and intraperitoneally and oxaliplatin given intraperitoneally were investigated.
CONCLUSIONS: The compatibility of 5-fluorouracil and oxaliplatin was documented showing no degradation of either drug when they were mixed in-vitro over 24 h. The pharmacokinetic analysis of hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin showed cytotoxic concentrations for 120 min. In order to maximize oxaliplatin\'s effect, both intravenous bolus and continuous infusion 5-fluorouracil was combined with early postoperative intraperitoneal chemotherapy (EPIC). In total, 200 mg/m2 of oxaliplatin was combined with a minimum of 1600 mg of 5-fluorouracil over the 24 -h treatment plan.
CONCLUSIONS: This perioperative FOLFOX treatment was completed in 2 patients and the clinical effectiveness as a result of this in-depth case reports was presented. Formal phase II studies, as a result of these pharmacokinetic and clinical investigations, have been initiated.

BACKGROUND: Diffuse malignant peritoneal mesothelioma (DMPM) is a disease in transition. Two decades ago this cancer had a median survival of 1 year. Recent reports in selected patients show a 5-year survival of 70% and median survival not reached at 10 years.
METHODS: Consecutive patients with a biopsy-confirmed diagnosis of DMPM, epithelial type, were treated by a consistent treatment plan. Cytoreductive surgery using peritonectomy procedures was always the first intervention. In the operating theater after all resections were complete but prior to intestinal reconstruction, hyperthermic intraperitoneal chemotherapy (HIPEC) using 2 cytotoxic agents was given. An intraperitoneal port was placed for normothermic intraperitoneal chemotherapy (NIPEC). Prospective data regarding pharmacokinetics, survival and adverse events were accumulated.
RESULTS: Six consecutive patients were treated. Three to 6 one-week long cycles of normothermic intraperitoneal paclitaxel were administered through an intraperitoneal port. No systemic chemotherapy was given. Pharmacokinetic studies were performed on 5 patients. Four patients are free of disease at 8, 13, 18, and 19 years and two patients died of disease 15 years after definitive treatment. Three of 6 patients had a grade III/IV adverse event related to intraperitoneal chemotherapy administration through a port.
CONCLUSIONS: The small number of patients treated with repeated doses of intraperitoneal paclitaxel cause these data to be interpreted with caution. However, the long-term benefit and favorable pharmacology of these patients suggests the need for further study. Adverse events from this intraperitoneal port were recorded in half of the patients.

BACKGROUND: Gastrointestinal cancer, gynecologic cancer and malignant peritoneal mesothelioma may disseminate widely to the surfaces of the abdomen and pelvis. In some patients this spread of the disease may find its way into a hernia sac.
METHODS: The Spigelian hernia is caused by a protrusion of the peritoneum of the anterior abdominal wall into the abdominal wall muscle. This peritoneal defect occurs through the semilunar line of Spiegel in or closely associated with the semicircular line of Douglas.
RESULTS: A patient presented with a large (11 cm greatest diameter) mass in the left lower quadrant. The mass was composed of malignant peritoneal mesothelioma and was anatomically located within the Spigelian hernia belt. At the time of cytoreductive surgery numerous other sites of malignant peritoneal mesothelioma were present within the abdomen and pelvis.
CONCLUSIONS: The left lower quadrant mass was a malignant peritoneal mesothelioma presenting within a Spigelian hernia defect. This phenomenon has not been previously reported.

BACKGROUND: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-established procedure commonly employed in the management of peritoneal carcinomatosis (PC) from tumors of various specific origins. However, it is not traditionally used in the management of PC of pancreatic origin due to various reasons, including the aggressive nature of pancreatic tumors.
METHODS: A 67-year-old female presented with a large amount of intractable malignant ascites. Computed tomography (CT) imaging showed a nodule in the right paracolic gutter. A diagnostic laparoscopy and omental biopsy showed a well-differentiated adenocarcinoma of pancreatic origin. She was initially not considered suitable for CRS and HIPEC due to apparent liver metastases on CT imaging and was arranged to undergo palliative chemotherapy; however, due to her large amount of refractory ascites and a suspected ruptured right krukenberg tumor, surgical intervention was offered. We performed CRS, bilateral salpingo-oophorectomy, and an omentectomy with a CC (completeness of cytoreduction) score of 1. HIPEC with mitomycin C was also administered. Notably, our patient remains clinically well at 48-months post CRS and HIPEC, with no signs or symptoms suggestive of tumor recurrence.
CONCLUSIONS: Despite the current lack of evidence supporting the use of CRS and HIPEC in the curation of PC of pancreatic origin, this case report highlights the importance of patient selection in determining suitability for CRS. In the presence of positive prognostic factors and favorable tumor histology, CRS and HIPEC is a potential curative procedure that could be offered to highly selected patients presenting with PC from a primary pancreatic malignancy.