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Jelly in the Tummy

Jelly in Belly turned out to be Cancer: Straits Times Oct 2011.

Peritoneal cancer treated by Peritonectomy and Heated Intraperitoneal Chemotherapy by Dr Melvin Look and Dr Tan Yu Men.

advanced-colorectal-cancer

Docs here successfully treat patient with rare disease that causes “jelly” to accumulate in abdomen.

Late last year, Mr. Wisnu Herdyanto, 53, thought he had lost some weight.

The scales showed he was just 2kg lighter at 62kg. Otherwise, he did not feel unwell. But an uneasy feeling drove him to see a doctor. So, the Indonesian citizen sought medic attention in Jakarta, where he lives and works.

The doctor did a blood test and a was told I had cancer in my intestines. but they did not know what kind of cancer said the father of two, who works as a general manager in an Indonesian Company.

He came to Singapore for a medical review in March this year. A positron emission tomography (PET scan showed exactly where his cancer was. It had started in the appendix, then ruptured and was producing a lot of mucin, a gelatinous material, in his abdominal cavity.

He had “jelly belly”. Also known as pseudomycoma peritonei, it is a rare disease in which large amounts of mucin accumulate in the abdominal cavity.

Although it is commonly caused by a ruptured tumour of the appendix, it could also happen in certain types of cancer of the colon, gallbladder, pancreas or stomach. The mucin accumulates gradually in the abdominal cavity and wraps around internal organs such as the liver.

Dr. Melvin Look, consultant surgeon at Mount Elizabeth Hospital, said the most common symptom of pseudomxoma is massive abdominal swelling due to the collection of mucin. Patients may also complain of abdominal discomfort, bloating, constipation, diarrhoea and sometimes pain.

Many patients, unfortunately, are diagnosed and undergo operations for appendicitis or other conditions, he said.

The prognosis of such patients is extremely poor, with a median survival period of about two years

For Mr. Wisnu, Dr. Look and Dr. Tan Yu Meng offered aggressive surgery with heated chemotherapy poured directly into his abdomen.

“For jelly belly, this is now established as the treatment of choice.” said Dr Tan, consultant general surgeon at Mount Elizabeth. It can improve five-year survival rates to more than 80 per cent,” he said.

Mr. Wisnu’s surgery in late May took 10 hours and was performed by Dr. Look and Dr. Tan.

They removed the part of the peritoneum which contained the tumour, some intra-abdominal fat, as well as the appendix, right colon and rectum, which were also heavily studded with cancer. The mucin was either scooped or suctioned out.

The abdominal cavity was then partially closed and heated chemotherapy drugs were poured inside by an oncologist to wash the organs for more than an hour.

Mr. Wisnu was discharged from hospital about 10 days later, weighing just 50kg. He said: “I was shocked when heard about the cancer and the type of cancer sounded frightening. But have full confidence the surgeon here. They explained everything to me and I told them to just go ahead and treat me, I feel very well now.”

His doctors said he has responded well to treatment and his prognosis is “reasonably good”. They started offering this treatment at Parkway Health hospitals in February this year.

They have operated on two other patients who had colorectal cancer that had spread to the peritoneum.

Depending on the complexity of the cases, such operations Parkway Health can cost from $70,000 to $100,000.

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