Management of an inguinal hernia in patients with pseudomyxoma peritonei

Eur J Surg Oncol. 2017 Jun;43(6):1083-1087. doi: 10.1016/j.ejso.2016.12.005. Epub 2017 Jan 6.


Background: Pseudomyxoma peritonei is a disease that results from a perforated mucinous neoplasm of the appendix so that mucinous ascites and mucin-producing tumor cells are widely disseminated in a characteristic pattern throughout the abdomen and pelvis. The intraabdominal mucus can accumulate in the inguinal canal and by physical examination be indistinguishable from the usual inguinal hernia.

Methods: A database of patients with pseudomyxoma peritonei was used to identify patients who had an inguinal hernia prior to or at the time of cytoreductive surgery (CRS) and perioperative hyperthermic chemotherapy (HIPEC). At the time of CRS, care was taken in all patients to remove the peritoneal lining of the inguinal canal. Patients who had the inguinal hernia repaired prior to definitive treatment with CRS and HIPEC had all tissue and mesh associated with prior herniorrhaphy resected.

Results: In 178 pseudomyxoma peritonei patients, 17 had a new onset or previously repaired inguinal hernia that required extraction of mucus and mucinous tumor from the hernia site. No repair of the open inguinal canal was attempted at the time of CRS. No recurrent inguinal hernias were recorded and no patients required an inguinal incision at a later time to resect progressive disease within the inguinal canal.

Conclusions: Inguinal hernias caused by mucinous ascites and tumor were definitively treated by cytoreductive surgery plus HIPEC. Extraction of tumor and peritoneum from the inguinal canal facilitates fibrous closure of the hernia defect so that hernia recurrence was not observed.

Keywords: Appendiceal mucinous neoplasm; Inguinal hernia; Inguinal hernia repair; Low grade appendiceal mucinous neoplasm; Mucinous ascites; Pelvic peritonectomy; Pseudomyxoma peritonei.

MeSH terms

  • Adenocarcinoma, Mucinous / pathology
  • Adenocarcinoma, Mucinous / therapy*
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / therapy*
  • Ascites
  • Cytoreduction Surgical Procedures / methods*
  • Doxorubicin / administration & dosage
  • Female
  • Fluorouracil / administration & dosage
  • Hernia, Inguinal / complications
  • Hernia, Inguinal / diagnostic imaging
  • Hernia, Inguinal / therapy*
  • Humans
  • Hyperthermia, Induced / methods*
  • Infusions, Parenteral
  • Inguinal Canal
  • Leucovorin / administration & dosage
  • Male
  • Middle Aged
  • Mitomycin / administration & dosage
  • Mucus
  • Peritoneal Neoplasms / complications
  • Peritoneal Neoplasms / diagnostic imaging
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Pseudomyxoma Peritonei / complications
  • Pseudomyxoma Peritonei / diagnostic imaging
  • Pseudomyxoma Peritonei / therapy*
  • Retrospective Studies
  • Tomography, X-Ray Computed


  • Mitomycin
  • Doxorubicin
  • Leucovorin
  • Fluorouracil