Diffuse malignant peritoneal mesothelioma presenting as intestinal obstruction

Our plain-English summary of Diffuse malignant peritoneal mesothelioma presenting as intestinal obstruction, by J. Griniatsos, S. Sougioultzis, N. Dimitriou, et al (Southern Medical Journal, 2009).

The study

• Authors: J. Griniatsos, S. Sougioultzis, N. Dimitriou, V. Vamvakopoulou, P. Alexandrou, V. Kyriakou, A. Tzioufas, E. Papalambros, M. Tzivras
• Journal: Southern Medical Journal
• Published: 2009;102(10):1061-4
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Diffuse malignant peritoneal mesothelioma (DMPM) represents 90% of all peritoneal forms of mesothelioma. It affects mainly patients 50-69 years old. In 50% of cases there is a history of asbestos exposure. The clinical presentation of the disease is not characteristic: nonspecific abdominal pain, weight loss, and abdominal distension are common. Ascites occurs in 90% of the patients. Bowel obstruction is a late manifestation. We present three patients with DMPM, without a history of asbestos exposure and without ascites, who presented with complete bowel obstruction. All patients underwent emergency operations, and palliative surgical procedures were performed. Each patient died within 3 to 6 months postoperatively.

In plain English

This case report came from LAIKO Hospital in Athens, Greece. The authors described three men with diffuse malignant peritoneal mesothelioma, a cancer of the abdominal lining, whose disease first showed as bowel obstruction; all three were eventually admitted with complete blockage. None had a history of asbestos exposure, and none had abdominal fluid (ascites) at first evaluation. A 32-year-old man had sarcomatoid-type tumor from the diaphragm to the lower pelvis. He received an ileostomy and died four months later. A 62-year-old man had four months of recurrent partial blockage, then an operation at another hospital whose biopsies were inconclusive. Four months later he was admitted with complete blockage, and a second operation found epithelial-type tumor. He was discharged six days later and died 80 days after that. A 36-year-old man had extensive bowel surgery for poorly differentiated epithelial-type tumor, developed lung metastases, and died six months later. The authors concluded that the disease can develop in people under 40 without a history of asbestos exposure and that ascites can be absent. They postulated that presenting with bowel obstruction is by itself a dismal prognostic sign.

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 (case series of three patients)
• Who was studied: Three men, aged 32, 62 and 36, treated at the authors' surgery department (LAIKO Hospital, University of Athens Medical School, Athens, Greece) for diffuse malignant peritoneal mesothelioma presenting as bowel obstruction; no dates of treatment given
• Exposure: None of the three patients had a history of asbestos exposure; no fiber type or occupational exposure was described
• Main results:
  • Patient 1 (32-year-old man): presented with complete bowel obstruction. MRI showed no free fluid in the peritoneal cavity. At surgery, hundreds of nodules covered the peritoneal surfaces from the hemidiaphragms to the lower pelvis. Histology showed sarcomatoid type. He received an ileostomy and died four months later.
  • Patient 2 (62-year-old man): had four months of recurrent partial intestinal obstruction. A laparotomy at another hospital produced inconclusive biopsies. Four months later he was admitted with complete bowel obstruction, and the authors' operation found epithelial-type tumor. He was discharged on postoperative day 6 and died 80 days later.
  • Patient 3 (36-year-old man): had extended small bowel resection, subtotal colectomy and other procedures for poorly differentiated epithelial-type tumor. Within seven weeks he developed constant abdominal pain, palpable masses and lung metastases. He died six months later.
  • None of the three patients had ascites at initial evaluation, and all had a rapid fatal course, with overall survival of less than 6 months
• The authors' conclusion: The authors concluded that diffuse malignant peritoneal mesothelioma can develop in people younger than 40 and without a history of asbestos exposure, and that ascites can be absent. They wrote that presentation with bowel obstruction is consistent with disseminated disease unsuitable for locoregional treatment, and postulated that it is a dismal prognostic factor by itself.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

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

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