大量の腹水があり，図１〜図８の↑は腹膜の腫瘍性病変で，図５〜図７の▲は肝転移性腫瘍を示唆する．上行結腸図１６の1は図７の横行結腸28まで数字順に展開するので，図８〜図１３の△は実質性腫瘤を示し，大網の転移性腫瘍の可能性が高い．胃に病変はなさそうで，図８〜図１２の白矢印の下行結腸は腫瘤を形成し，不整にやや強く造影され，辺縁も不整で癌であろう．腹水の細胞診でclass V，ガストログラフィン造影で脾弯曲部近くの下行結腸に辺縁不整な狭窄像を示し（図Aと図B：↑），内視鏡検査による生検でmoderately differentiated adenocarcinomaと診断された．

参考症例（原発不明の癌性腹膜炎）：59歳男性．3週間前から腹部膨満が出現し次第に増強，食欲もなくなり来院した．熱はない．腹部は膨満しているが圧痛はない．腹水の細胞診はclass IIであった．
腹水（※）があり，横行結腸（T1〜T5）の走行が確認されれば，尾側の図４〜図７の↑は腹壁直下に位置し，大網の転移性腫瘍を強く示唆する．試験開腹がなされ，大網腫瘤，小腸漿膜と腹膜に無数の白色結節を認めた．大網腫瘤の病理検査でdisseminated adenocarcinomaと診断されたが原発巣は不明であった．2週間後には腹水が増量した（図１１〜図１５）．

文献考察：癌性腹膜炎．腫瘍細胞減少術とマイトマイシンC温熱併用腹腔内化学療法を460例に行い，27.8％の5年生存率が得られた．
J Am Coll Surg. 2007 May;204(5):943-53; discussion 953-5.
Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures.
Levine EA, Stewart JH, Russell GB, Geisinger KR, Loggie BL, Shen P.

BACKGROUND: Peritoneal dissemination of abdominal malignancy (PSD) has a clinical course marked by bowel obstruction and death. We have been using aggressive cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (IPHC) to treat PSD. The purpose of this article was to review our experience with IPHC. STUDY DESIGN: A prospective database of patients undergoing IPHC has been maintained since 1991. Patients were uniformly evaluated and treated. Demographics, performance status, resection status, primary site, and experience quartile were compared with outcomes. Univariate and multivariate analyses were performed. RESULTS: A total of 460 patients underwent 501 IPHC procedures. Average age was 53.0 years, and 50.4% were women. The 30-day mortality rate was 4.8%, the complication rate was 43%, and median hospital stay was 9 days. Median followup was 55.4 months, median survival was 22.2 months, and 5-year survival rate was 27.8%. Factors correlating with improved survival were performance status (p=0.0001), primary tumor (p=0.0001), resection status (p=0.0001), complications (p=0.002), previous IPHC (p=0.006), and experience quartile (p=0.031). On multivariate analysis, primary tumor site, performance status, resection status, and development of complications (p