eP348 - The Role of Heated Intraperitoneal Chemotherapy in the Setting of Recurrent Mucinous Adenocarcinoma and Suspected Crohn’s Disease

Purpose/Background: Inflammatory bowel disease (IBD) is a known risk factor for colorectal cancer. Mucinous and signet ring adenocarcinoma are seen with higher incidence amongst patients with Crohn’s disease and tend to present at an earlier age. Mucinous adenocarcinomas feature an extracellular mucin comprising more than 50% of the tumor which can rupture. The extent of peritoneal spread is measured by the Peritoneal Cancer Index (PCI), scored from 0-39 based on tumor location and size.Methods/Interventions: A 40-year-old male presented with chronic right lower quadrant abdominal pain. Colonoscopy revealed colitis and an inflammatory granuloma which measured 10x9x8cm on CT. The granuloma and pain persisted despite treatment for suspected Crohn’s disease with biologic agents. Due to failed medical management, he underwent a robotic-assisted right hemicolectomy and end ileostomy.Results/Outcomes: Intra-operatively, patient was found to have a chronic right colonic perforation into the sidewall and retroperitoneum with evidence of mucinous tissue. Pathology verified a T4bN1b invasive mucinous adenocarcinoma with signet ring cell component. He underwent eight cycles of FOLFOX. A 4-month post-operative CT scan showed a 3.4cm right paracolic gutter collection suspicious for recurrent mucinous tumor with a PCI score of 2 indicating low disease burden and candidacy for cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC) with 68mg of Mitomycin C. Intra-operatively there was a 3.5cm right upper quadrant necrotic mass densely adhered to the retroperitoneum this was resected en bloc. Additionally, an omentectomy and end ileostomy reversal was performed. He had an unremarkable post-operative course. He is currently receiving adjuvant FOLFOX chemotherapy.Conclusion/

Discussion: Cytoreductive surgery and HIPEC is a treatment option for colorectal cancer with peritoneal involvement. Herein we discuss an interesting case in which HIPEC was used for the treatment of recurrent mucinous adenocarcinoma in a patient with suspected Crohn’s disease. Some studies question the efficacy of HIPEC in patients with Crohn’s disease. Although the patient’s clinical course is ongoing it is optimistic. Additional studies are needed to further investigate and add to the literature. Additionally, it is unclear whether this patient has IBD or rather malignancy masquerading as IBD.The Role of Heated Intraperitoneal Chemotherapy in the Setting of Recurrent Mucinous Adenocarcinoma and Suspected Crohn’s DiseaseIntraoperative photo of mass from right partial colectomy