Peritoneal mesothelioma causing small bowel obstruction in COVID-19 positive patient

Our plain-English summary of Peritoneal mesothelioma causing small bowel obstruction in COVID-19 positive patient, by A. Trivedi, A. Hlayhel, Z. Hooda, et al (Journal of Surgical Case Reports, 2022).

The study

• Authors: A. Trivedi, A. Hlayhel, Z. Hooda, L. Foran, S. Wessner
• Journal: Journal of Surgical Case Reports
• Published: 2022;2022(10):rjac469
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Mesothelioma is a disease process that can present in a variety of locations including the pleural, peritoneum and pericardium. Malignant peritoneal mesothelioma has been known to be a particularly aggressive type of tumor. We report a case of a patient who presented with a small bowel obstruction whose pathology revealed peritoneal malignant mesothelioma.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2022.

In plain English

This is a case report of one patient, an 81-year-old man with a 10-pack-year smoking history, written by surgeons at St. Joseph's University Medical Center in Paterson, New Jersey. He came to hospital with abdominal swelling and bloating after about two weeks of constipation. A CT scan showed a small bowel obstruction at the terminal ileum, and he tested positive for COVID-19. After 6 days of non-surgical treatment did not resolve the obstruction, surgeons found a mass at the terminal ileum and removed the right side of the colon. Tissue testing showed diffuse peritoneal malignant mesothelioma, epithelioid subtype, with no lymph node involvement and negative margins. The man had worked in a factory that made wire hangers, which the authors said could have been a potential source of asbestos exposure. No fiber type was named. He refused chemotherapy and was receiving immunotherapy. Scans showed no distant spread, but a mass was found in the abdominal wall and peritoneum. The authors concluded that malignant peritoneal mesothelioma may be a differential diagnosis in a patient with a small bowel obstruction.

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 of a single patient
• Who was studied: One 81-year-old man, reported by authors from the Department of Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA. No dates are given.
• Exposure: The patient had worked in a factory that manufactured wire hangers. No fiber type, duration or amount of exposure was reported.
• Main results:
  • The authors said the wire hanger factory work could have been a potential source of asbestos exposure.
  • The patient had a 10-pack-year smoking history.
  • The patient presented with abdominal distention and bloating after about 2 weeks of recurrent constipation.
  • A CT scan showed a small bowel obstruction with a transition point at the terminal ileum.
  • The patient was positive for COVID-19.
  • A repeat CT after 6 days of conservative management showed persistent small bowel distention and increased ascites.
  • At exploratory laparotomy, a mass was found at the terminal ileum and a right hemicolectomy was performed.
  • Final pathology showed diffuse peritoneal malignant mesothelioma with no nodal involvement and negative margins.
  • The tumor was classified as diffuse peritoneal malignant mesothelioma, epithelioid subtype.
  • The tumor penetrated through the ileocecal muscularis propria and submucosa.
  • Immunohistochemistry showed strong positive reactions with Calretinin, CK5, CK6, WT-1 and D2-40.
  • The patient refused chemotherapy and was receiving immunotherapy with nivolumab and ipilimumab.
  • Repeat CT and PET scans showed no evidence of distant metastatic disease.
  • A mass was found in the right lateral anterior abdominal wall and peritoneum.
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma may be a differential diagnosis in a patient with a small bowel obstruction.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Mesothelioma, Peritoneum, Pericardium, Pathology.

Related studies

• Primary Peritoneal Mesothelioma Resulting in Small Bowel Obstruction: A Case Report and Review of Literature — S.C. Frontario, A. Loveitt, et al. (2015)
• Benign Cystic Peritoneal Mesothelioma Revealed by Small Bowel Obstruction — K. Bray Madoué, M. Boniface, et al. (2016)
• Diffuse malignant peritoneal mesothelioma presenting as small bowel obstruction — A.R. Tagliaferri, G. Melki, et al. (2023)
• Mucin-positive epithelial mesothelioma of the peritoneum: small bowel involvement — J.H. Kim, K.Y. Kwon, et al. (2011)
• Peritoneal metastases from small bowel cancer: Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands — T.R. van Oudheusden, V.E. Lemmens, et al. (2015)
• Metastatic malignant pleural mesothelioma masquerading as a case of acute abdomen secondary to small bowel perforation — K. Alkhayal (2016)

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