2016 Volume 49 Issue 10 Pages 1016-1022
A 74-year-old man with abdominal distension visited our hospital. CT showed massive ascites throughout the peritoneal space and a 3 cm-sized ruptured cystic tumor in the body of the pancreas. The ascites collected by echo-guided puncture was gelatinous. Endoscopic retrograde pancreatography revealed mucin secretion through an enlarged papilla of Vater and a saclike outpouching that was suggestive of a rupture of the tumor. We diagnosed this case as pseoudomyxoma peritonei caused by a rupture of intraductal papillary mucinous neoplasm. Distal pancreatectomy and cytoreductive surgery of mucinous material were performed. Abundant yellowish gelatinous material was seen in the peritoneal cavity, and fistula formation was identified between the mucinous pooling of bursa omentalis and the cystic tumor of the body of the pancreas. Histopathological analysis of the resected tumor revealed pseudomyxoma peritonei associated with intraductal papillary mucinous carcinoma. Intraductal papillary mucinous neoplasm has been documented to infrequently result in fistula formation to nearby organs, but it is rare that a rupture of intraductal papillary mucinous neoplasm caused pseudomyxoma peritonei.
