Fig. 14

Peritoneal carcinomatosis secondary to a recurrent gastric adenocarcinoma in a 41-year-old woman. a, b Axial CT image shows the primary neoplasm as a segmental and concentric thickening of the gastric antrum (red arrows) and a normal mesenteric root, with no ascites and no signs of peritoneal dissemination. Total gastrectomy was performed and H&E stain photomicrograph (c) of the primary tumor showed a poorly differentiated gastric carcinoma with isolated signet ring cells (red arrows). Eleven months after surgery the patient complained of abdominal fullness, pain and constipation. Abdominal CT (d, e) was carried out showing pelvic ascites (white asterisk), peritoneal thickening (white arrows) and increased attenuation of the mesenteric root fat suggestive of “stellate mesentery” (white oval in d, white circle in e) with distension of adjacent ileal loops (blue arrows), findings that raised the suspicion of peritoneal recurrence. Initial laparoscopy did not allow an adequate visualization of the mesenteric root and ascitic fluid cytology was negative for malignancy, so eventually exploratory laparotomy was performed to confirm the presence of peritoneal disease. Intraoperative view (f) showed fixation and tethering of the ileal loops secondary to confluent plaque-like whitish lesions in the small bowel serosa (white circle), representing extensive tumoral involvement with retraction of the adjacent mesentery