Excessive accumulation of mucin 2 (MUC2; a gel-forming secreted mucin) protein in the peritoneal cavity is the major cause of morbidity and mortality in pseudomyxoma peritonei (PMP). Hypoxia (hypoxia-inducible factor-1α; HIF-1α) has been shown to regulate the expression of similar mucins (eg,
A 44-year-old white male with pseudomyxoma peritonei and intractable malignant ascites is described. This patient underwent three peritoneovenous shunt procedures utilizing first the LeVeen shunt and finally the Denver shunt in a surgical attempt at palliative decompression of his malignant ascites.