A Case Report of Peritoneal Mesothelioma as an Acute Abdomen Mimic: A Rare Presentation and Diagnostic Challenges

Our plain-English summary of A Case Report of Peritoneal Mesothelioma as an Acute Abdomen Mimic: A Rare Presentation and Diagnostic Challenges, by L. Fadl, M. Fadl, O. Fadl, et al (Curēus, 2024).

The study

• Authors: L. Fadl, M. Fadl, O. Fadl, S.G. Thaplar G Gouda, H. Mirza
• Journal: Curēus
• Published: 2024;16(11):e74598
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare and aggressive cancer often linked to asbestos exposure. This case report presents a 60-year-old man with a history of asbestos exposure who developed MPM, initially presenting with acute abdominal pain, an uncommon mimic of the acute abdomen. Diagnosing MPM is challenging due to its vague symptoms, often leading to delayed diagnosis. Additionally, the patient developed internal jugular vein thrombosis, a rare complication associated with malignancies. This case highlights the rare presentation of peritoneal mesothelioma as an acute abdomen mimic, the diagnostic complexities associated with MPM, and the rare type of thromboembolic event in this case.

Copyright © 2024, Fadl et al.

In plain English

This case report describes one patient. In early April 2024, a 60-year-old man who had worked in building trades went to hospital with sudden, severe central abdominal pain and nausea that resembled a surgical emergency. More than 30 years earlier he had worked in a building with asbestos. He had also worked in a foundry where asbestos ropes were used, sometimes draped around workers' necks or held in their mouths. A CT scan showed widespread deposits in the abdominal lining and a 38.8 mm mass near the rectum. The mass was at first thought to be possibly colorectal cancer. A biopsy of a lesion at the navel confirmed epithelioid mesothelioma, and he was diagnosed with malignant peritoneal mesothelioma. He started immunotherapy with ipilimumab and nivolumab. In June 2024 a blood clot was found in the right internal jugular vein in his neck, and he was given anticoagulation. By November 2024 the disease had progressed, 4.2 L of abdominal fluid was drained, and he was under palliative care. The authors concluded that the case shows a rare acute-abdomen-like presentation and the difficulty of diagnosing this cancer.

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 60-year-old man who had worked in building trades and had a history of asbestos exposure. He presented to hospital in early April 2024. The authors are based at NHS trusts in the West Midlands, UK.
• Exposure: Occupational asbestos exposure; the fiber type is not stated. He worked in a building with asbestos more than 30 years earlier. He also worked in a foundry where asbestos ropes were used, sometimes draped around workers' necks or held in their mouths.
• Main results:
  • CT of the abdomen and pelvis showed extensive omental and peritoneal deposits throughout the abdomen and pelvis.
  • A 38.8 mm mass was seen near the rectosigmoid junction, involving the bowel wall.
  • A CT of the chest showed no evidence of lung involvement.
  • The rectosigmoid lesion was initially misidentified as a possible colorectal cancer, which delayed the diagnosis.
  • An ultrasound-guided biopsy of the umbilical lesion confirmed epithelioid mesothelioma, and the final diagnosis was malignant peritoneal mesothelioma.
  • The peritoneal multidisciplinary team started immunotherapy with ipilimumab and nivolumab.
  • On June 18, 2024, CT suggested a blood clot in the right internal jugular vein. His D-dimer was 1147.0 ng/ml (normal range 0-500 ng/ml), and anticoagulation was started.
  • In November 2024, CT showed progression of peritoneal and omental deposits with ascites. He was admitted and 4.2 L of fluid was drained.
  • At the time of the report the patient was under the care of the palliative team.
• The authors' conclusion: The authors concluded that the case shows a rare presentation of malignant peritoneal mesothelioma as a mimic of an acute abdomen and the diagnostic challenges of the condition. They attributed the internal jugular vein clot to the hypercoagulable state in this cancer.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Asbestos Exposure.

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