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A Sixty-year-old male presented with gross abdominal distention of six months duration.

There was no pain or fever. On investigation was found to having a huge cyst in the abdominal cavity occupying the entire abdominal cavity and was reported as a Mesenteric cyst.

After the initial assessment, he was planned for ultrasound-guided cyst aspiration followed by Laparoscopic removal of the cyst.

As planned the cyst was aspirated under ultrasound guidance. As the the cyst fluid was too thick, a 5 mm port was inserted under the guidance and about 4 liters of very thick fluid was aspirated. And the laparoscopic ports were inserted and most of the fluid was aspirated. The sediments were very thick hence converted to open and the contents evacuated- In all 15 liters.

It was found to be pseudo myxoma peritonei  and not a mesenteric cyst. The entire wall was excised except the ileocaecal area which was inflamed and highly vascular.

Histopathology confirmed the diagnosis of pseudo myxoma peritonie.

The patient was subsequently referred to an oncologist for further management.

Pseudomyxoma peritoneum is a clinical condition caused by cancerous cells (mucinous adenocarcinoma) that produce abundant mucin or gelatinous ascites.[1] The tumors cause fibrosis of tissues and impede digestion or organ function, and if left untreated, the tumors and mucin they produce will fill the abdominal cavity. This will result in compression of organs and will destroy the function of the colon, small intestine, stomach, or other organs. Prognosis with treatment in many cases optimistic,[2] but the disease is lethal if untreated, with death by cachexia, bowel obstruction, or other types of complications.

This disease is most commonly caused by an appendiceal primary cancer (cancer of the appendix); mucinous tumors of the ovary have also been implicated. Pseudomyxoma peritonei (PMP) is a rare disease with an estimated incidence of 1 per million per year