Pseudomyxoma Peritonei Masquerading as Decompensated Cirrhosis: A Diagnostic Challenge with Surgical Management in a Resource-Limited Setting in Tanzania

Abstract

Pseudomyxoma peritonei (PMP) is a rare syndrome of mucinous ascites that often mimics common conditions such as decompensated cirrhosis. Diagnostic delays are frequent, especially in resource-limited settings where advanced imaging and histopathology are unavailable.

A 62-year-old Tanzanian woman presented with six months of progressive abdominal distension, orthopnea, and weight loss. She had been treated for decompensated cirrhosis at a district hospital for three months without improvement. At our facility, a standard paracentesis catheter failed to drain fluid; subsequent needle aspiration yielded jelly-like mucinous material. Bedside ultrasound revealed a multiloculated left ovarian mass (15 × 10 × 12 cm) and extensive echogenic ascites with restricted movement, while the liver, spleen, and portal vein were normal, effectively excluding cirrhosis. Emergency laparotomy found 12 liters of mucinous fluid from a ruptured left ovarian mucinous cystadenoma. The appendix was grossly normal. A left oophorectomy was performed. Formal histopathology was not available because the facility lacks pathology services, and the patient could not afford a referral. Two months after surgery, the patient remained well with no clinical evidence of recurrent ascites.

In resource-limited settings, a failed paracentesis yielding viscous, jelly-like fluid is a critical bedside clue to PMP. Ultrasound can confirm a pelvic mass and gelatinous ascites, guiding timely surgical intervention even when definitive therapies such as Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and histopathology are inaccessible.