Novel Use of Intravesical Bromelain and N-acetylcysteine for Pseudomyxoma Peritonei with Bladder Involvement: Case Series

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Introduction: Pseudomyxoma peritonei (PMP) is a rare and challenging neoplastic condition associated with great morbidity when left untreated.The standard treatment is cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC).However, not all patients are suitable candidates for extensive operative management, necessitating alternative avenues to symptom management.Bromac is a combination of bromelain and N-acetylcysteine which demonstrates mucolytic effects and has been shown to alleviate the compressive effects of PMP.Case Presentation: This case series describes the symptomatology and history of two patients with PMP with bladder involvement.Due to a combination of personal and medical factors, these patients sought alternatives to operative management.We detail the novel treatment of PMP with intravesical Bromac and the clinical response to this therapy.Conclusion: This case series demonstrates a symptomatic and radiological improvement when intravesical Bromac is used to manage PMP with bladder involvement.Further research is required to polish the dosing, frequency, and method of administration

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