Pseudomyxoma Peritonei (PMP) is an uncommon condition characterised by diffuse mucinous ascites or “jelly belly”, and multifocal peritoneal implants. PMP commonly arises from an occult epithelial malignancy of the appendix. Surgical treatment involves a series of peritonectomy procedures and visceral resections to achieve macroscopic tumour clearance followed by heated intraperitoneal chemotherapy as described by Sugarbaker (Figs. 1, 2, 3, 4, 5, 6, 7, 8, 9).

Fig. 1
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Preoperative cross-sectional imaging showing diffuse intraperitoneal involvement with mucinous ascites

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Fig. 2
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Immediate findings at laparotomy showing “jelly belly” appearances

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Fig. 3
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Perforated primary appendiceal tumour

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Fig. 4
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Right parietal peritonectomy

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Fig. 5
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Stomach reflected upwards after greater and lesser omentectomy and splenectomy with left gastric artery preserved

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Fig. 6
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Pelvic peritonectomy and anterior resection with bladder stripped of peritoneum and retracted forward

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Fig. 7
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Liver capsulectomy with high power diathermy, and cholecystectomy

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Fig. 8
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Heated intraoperative peritoneal chemotherapy with mitomycin C at 41°C by coliseum technique

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Fig. 9
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Flat abdomen following complete cytoreduction with tube drains for postoperative intraperitoneal chemotherapy with 5-fluorouracil

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