title: Peritoneal mesothelioma presenting as an acute surgical abdomen due to jejunal perforation.
abstract: 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.
authors.affiliation: 2nd Department of Surgery, 417 Army Veterans General Hospital NIMTS, Athens, Greece. nikos_salemis@hotmail.com
authors.forename: Nikolaos S
authors.initials: NS
authors.lastname: Salemis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Tsiambas
authors.forename: Stavros
authors.initials: S
authors.lastname: Gourgiotis
authors.forename: Ageliki
authors.initials: A
authors.lastname: Mela
authors.forename: Andreas
authors.initials: A
authors.lastname: Karameris
authors.forename: Efstathios
authors.initials: E
authors.lastname: Tsohataridis
mesh_terms: 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