Pseudomyxoma Peritonei Presenting as Inguinal Hernia

implanted due to continued risk of arrhythmia from electrolyte loss from the ileostomy. The QTc came down to 454ms and BNP fell to 179pg/ml at discharge. QT prolongation is the surface ECG manifestation of abnormal repolarisation of myocardial cells due to problems with cellular ion channels. The disorder is classified as either congenital or acquired. Acquired QT prolongation may be due to: 1. Electrolyte depletion, particularly potassium or magnesium, 2. Drugs that affect myocardial ion channels 3. A feature of tako-tsubo cardiomyopathy, a catecholamine induced metabolic disorder of myocardial cells caused by physical or emotional stress, especially seen in older females 1,2. A reference list of drugs causing QT prolongation is available from the University of Arizona (http://www.azcert.org) or the British National Formulary. Initial presentation and ECGs in tako-tsubo cardiomyopathy are similar to an anterior ST or non-ST segment myocardial infarction but often with QT prolongation. A small troponin rise may be seen but coronary arteries are normal with a characteristic " apical ballooning " or Japanese octopus pot (" tako-tsubo ") pattern seen on ventriculography. Beta-blockade is a key element of treatment. The ventricular changes are mostly reversible if the patient survives the acute phase 3. Our patient had all three causes of an acquired QT prolongation-excessive secretion from her ileostomy producing hypomagnesaemia, daily ondansetron and fluoxetine therapy, and acute tako-tsubo cardiomyopathy. We believe the development of tako-tsubo cardiomyopathy exacerbated our patient's pre-existing QT prolongation to a degree where potentially fatal arrhythmias occurred. A case of congenital long QT syndrome and tako-tsubo cardiomyopathy with torsades de pointes has been described 4 but MEDLINE and PubMed searching (keywords: long QT and cardiomyopathy) revealed no acquired cases. Tako-tsubo cardiomyopathy induced by physical or emotional stress may exacerbate an underlying long QT syndrome with risk of sudden cardiac death. A pathophysiological study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography. al. Association of tako-tsubo cardiomyopathy and long QT syndrome. Pseudomyxoma peritonei (PMP) is an uncommon disease with varied presentations. We present two cases presenting at inguinal hernia repair. case 1: A 41 year-old man presented for right inguinal hernia repair. An encysted swelling was discovered at surgery. Histopathology of the sac showed chronic inflammatory tissue containing lakes of mucin but no neoplastic epithelial cells. Postoperative CT scan showed thickening around the caecum with a fluid collection and abnormality related to the appendix. Colonoscopy and biopsies were normal. The patient was referred …