Malignant peritoneal mesothelioma presenting as recurrent adhesion obstruction in general surgery: a case report

Our plain-English summary of Malignant peritoneal mesothelioma presenting as recurrent adhesion obstruction in general surgery: a case report, by V. Naraynsingh, M.J. Ramdass, C.L. Lum (Journal of Medical Case Reports, 2011).

The study

• Authors: V. Naraynsingh, M.J. Ramdass, C.L. Lum
• Journal: Journal of Medical Case Reports
• Published: 2011;5:420
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Malignant peritoneal mesothelioma is a well-described entity in many reports in the literature in which it has been associated with asbestosis. However, there is no information describing the gross appearance and cardinal features seen during laparotomy, hence it is easy for the unwary surgeon to miss the diagnosis of this rare condition.

Case Presentation: A 49-year-old man of African descent presented to our hospital with a three-month history of weight loss, anorexia, abdominal distension, and general signs of cachexia and ascites on second presentation. At first presentation one year prior to this, he had undergone a laparotomy at our institution by a different team for intestinal obstruction secondary to adhesions with no biopsy taken. The patient's condition subsequently progressively deteriorated, and investigations including upper and lower gastrointestinal endoscopies and computed tomography of the abdomen were inconclusive, except for some free fluid in the peritoneal cavity and diffuse, mild thickening of the gut wall and mesentery. A second-look exploratory laparotomy revealed widespread nodular thickening of the visceral peritoneum with a striking, uniformly diffuse, erythematous, and velvety appearance. The peritoneal biopsy histology showed that the patient had malignant peritoneal mesothelioma. His condition deteriorated rapidly, and he died eight weeks after surgery.

Conclusion: Our report aims to increase the diagnosing clinician's awareness of the cardinal features of malignant peritoneal mesothelioma and thus reduce diagnostic errors and delays in treatment.

In plain English

This was a case report from the Department of Surgery, General Hospital, Port of Spain, Trinidad. It described one 49-year-old man of African descent, a non-smoker, who had been exposed to asbestos between the ages of 23 and 29 while working in a pipe-insulating factory. The article does not name the fiber type. At his first hospital visit he had vomiting and a swollen abdomen. Surgeons operated, diagnosed adhesions (bands of scar tissue), and took no biopsy. He came back with weight loss, poor appetite, abdominal swelling, wasting and fluid in the abdomen. Endoscopies and a CT scan showed only free fluid and mild thickening of the gut wall and mesentery, and his blood tests were normal. A second operation found widespread nodular thickening of the lining of the abdominal organs, with a red, velvety look. A biopsy showed malignant peritoneal mesothelioma. He received chemotherapy but died eight weeks after surgery. The authors concluded that occupational asbestos exposure was a critical factor in the diagnosis. They aimed to make surgeons more aware of how this cancer looks during an operation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 49-year-old man of African descent, a non-smoker, treated at General Hospital, Port of Spain, Trinidad; dates of treatment not given
• Exposure: Occupational asbestos exposure from ages 23 to 29 while working in a pipe-insulating factory; fiber type and dose not stated
• Main results:
  • At the first operation, done for suspected small-bowel obstruction, surgeons diagnosed adhesions and took no biopsy
  • At his second presentation, the CT scan showed a thickened gut wall and mesentery with fluid in the abdomen (ascites); his blood tests were normal
  • A second-look operation found widespread nodular thickening of the visceral peritoneum with a red, velvety appearance; biopsy confirmed malignant peritoneal mesothelioma
  • Surgical removal of the tumor (cytoreduction) was not done because the disease was diffuse and advanced, and heated intra-peritoneal chemotherapy was not available at the hospital
  • The patient received systemic chemotherapy, worsened rapidly, and died eight weeks after surgery
• The authors' conclusion: The authors concluded that the patient's occupational asbestos exposure was a critical factor in the diagnosis. Their report aimed to raise clinicians' awareness of how malignant peritoneal mesothelioma looks at operation, to reduce diagnostic errors and delays.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Laparotomy, Cachexia, Ascites, Biopsy, Peritoneal Cavity, Mesentery, Peritoneum.

Related studies

• Diffuse malignant peritoneal mesothelioma presenting as intestinal obstruction — J. Griniatsos, S. Sougioultzis, et al. (2009)
• Diffuse malignant peritoneal mesothelioma presenting as small bowel obstruction — A.R. Tagliaferri, G. Melki, et al. (2023)
• "Signet-ring" cells--a caveat in the diagnosis of a diffuse peritoneal mesothelioma occurring in a lady presenting with recurrent ascites: an unusual case report — B. Rekhi, S. Pathuthara, et al. (2010)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Repeated cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with recurrent peritoneal carcinomatosis — N. Vassos, T. Förtsch, et al. (2016)

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