Peritoneal mesothelioma presenting as an acute surgical abdomen due to jejunal perforation.
BACKGROUND
Peritoneal mesothelioma is a rare disease associated with poor prognosis. Acute abdomen as the first presentation is an extremely rare occurrence. We report an exceptional case of a patient who was found to have a jejunal perforation due to infiltration of peritoneal mesothelioma.


METHODS
A 62-year-old man was admitted with clinical signs of peritonitis. Computerized tomographic scans showed a mass distal to the ligament of Treitz, thickening of the mesentery and a small amount of ascites.


RESULTS
Emergency laparotomy revealed a perforated tumor 15 cm distal to the ligament of Treitz and diffuse peritoneal disease. Segmental small bowel resection and suboptimal cytoreduction were performed. Histopathology and immunohistochemistry showed infiltration of malignant mesothelioma. During the postoperative period pleural mesothelioma was also diagnosed. Despite adjuvant chemotherapy, the patient died of disseminated progressive disease 7 months after surgery.


CONCLUSIONS
Peritoneal mesothelioma is a rare malignancy with grim prognosis. Small bowel involvement is a poor prognostic indicator. Our case of a small bowel perforation due to direct infiltration by peritoneal mesothelioma appears to be the first reported in the English literature.
Salemis
Nikolaos S
NS
2nd Department of Surgery, 417 Army Veterans General Hospital NIMTS, Athens, Greece. nikos_salemis@hotmail.com
Tsiambas
Evangelos
E
Gourgiotis
Stavros
S
Mela
Ageliki
A
Karameris
Andreas
A
Tsohataridis
Efstathios
E
D000006:Abdomen, Acute / Q000209:etiology*; D001202:Ascitic Fluid / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007416:Intestinal Perforation / Q000209:etiology*; D007580:Jejunal Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008654:Mesothelioma / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed