Peritoneal mesothelioma as an incidental finding during inguinal hernia surgery

Our plain-English summary of Peritoneal mesothelioma as an incidental finding during inguinal hernia surgery, by J.R. Andresen, E.L. Monteiro, M.O. Liedke (Journal of Surgical Case Reports, 2026).

The study

• Authors: J.R. Andresen, E.L. Monteiro, M.O. Liedke
• Journal: Journal of Surgical Case Reports
• Published: 2026;2026(1):rjaf1055
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma is a rare tumor disease, usually associated with asbestos exposure, which is often only diagnosed at an advanced stage. We report the case of a 52-year-old patient who was found to have marked ascites during surgery for a recurrent inguinal hernia. Subsequent diagnostics, including diagnostic laparoscopy, established the diagnosis of malignant epithelioid peritoneal mesothelioma. After tumor reduction by omentum resection and hyperthermic intraperitoneal chemotherapy, a complete remission was achieved. The case underlines the importance of differentiated clarification of unclear intra-abdominal findings in high-risk patients with possible asbestos exposure.

© The Author(s) 2026. Published by Oxford University Press and JSCR Publishing Ltd.

In plain English

This is a case report about one patient. A 52-year-old man came for surgery on a hernia that had returned in his right groin. Ultrasound beforehand showed fluid in the abdomen (ascites), and the hernia was not repaired then because of a suspicious finding. He reported growing abdominal fullness and a 3 kg weight loss over two months, and had been exposed to asbestos at work as a master electrician in old houses. A CT scan showed tumor spread across the abdominal lining with no primary tumor found; the abdominal fluid showed no cancer cells. Biopsies taken by keyhole surgery showed malignant high-grade epithelioid mesothelioma of the peritoneum. Surgeons removed the affected omentum and part of the peritoneum, without removing all tumor, then gave heated chemotherapy inside the abdomen (HIPEC). The article reported complete remission over 24 months of follow-up, with mild pelvic fluid remaining. The hernia was later repaired. The authors concluded that this tumor can appear unexpectedly during routine surgery and that unclear abdominal findings need thorough investigation, especially after asbestos exposure.

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 (one patient)
• Who was studied: One 52-year-old man who presented for surgery on a recurrent right groin (inguinal) hernia; the article does not state the country or dates of care
• Exposure: Occupational asbestos exposure reported while working as a master electrician in old houses; no fiber type or dose is given
• Main results:
  • Because ultrasound and MRI before surgery showed ascites and a suspicious appearance of the tunica vaginalis, the recurrent hernia was not repaired at that time
  • The patient reported a 3 kg weight loss over the previous two months, along with increasing abdominal fullness
  • CT of the chest and abdomen showed peritoneal carcinomatosis with ascites, without evidence of a primary tumor
  • Cytology of the ascites fluid showed no evidence of malignancy
  • Diagnostic laparoscopy showed nodular tumor deposits in all four quadrants, on the peritoneum and the greater omentum
  • Biopsies of the peritoneum and greater omentum showed malignant high-grade epithelioid mesothelioma of the peritoneum
  • The affected greater omentum and part of the peritoneum were removed laparoscopically; complete cytoreduction was not achieved in this patient
  • HIPEC was well tolerated and was followed by complete remission during the 24-month follow-up period
  • PET and repeat CT showed no tumor recurrence, although mild ascites remained in the pelvis
  • The hernia was later repaired by the Lichtenstein open technique and remained recurrence-free after a further 30 days
• The authors' conclusion: The authors concluded that peritoneal mesothelioma can occur as a rare incidental finding during routine surgery, and that unclear intra-abdominal findings call for consistent diagnostic clarification, particularly when there is a history of asbestos exposure. They also concluded that tumor reduction combined with HIPEC can lead to complete remission.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Inguinal Hernia, Asbestos Exposure, Ascites, Diagnostic Laparoscopy, Epithelioid, Omentum, HIPEC.

Related studies

• Incidental finding of metastatic mesothelioma in an inguinal hernia sac: a case report — A. Al-Bitar, M. Shwin (2025)
• An unusual presentation of malignant mesothelioma: the incidental finding of tumor in the hernia sac during herniorrhaphy — J. Brenner, P.P. Sordillo, et al. (1981)
• Peritoneal mesothelioma masquerading as an inguinal hernia — S. Chakravartty, J.C. Singh, et al. (2011)
• Peritoneal mesothelioma masquerading as an inguinal hernia — S. Chakravartty, J.C. Singh, et al. (2012)
• Fine-needle aspiration of a well-differentiated papillary mesothelioma in the inguinal hernia sac: A case report and review of literature — Y.Y. Wheeler, F. Burroughs, et al. (2009)
• Incarcerated inguinal hernia from metastatic pleural mesothelioma: PET/CT imaging — V.X. Nguyen, B.D. Nguyen, et al. (2012)

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