Malignant peritoneal mesothelioma – a rare cause of laparotomy

Mesotheliomas are aggressive tumours of the serosal membrane that covers the internal organs of the body. The most frequently affected surfaces are pleura (65–70%), peritoneum (30%), tunica vaginalis testis, and pericardium (1–2%) [1, 2]. Peritoneal mesothelioma was first described in 1908 by Miller and Wynn [3, 4]. The disease incidence depends on geographic region and ranges from about 7 to 40 per 1,000,000 in industrialised countries (i.e. Britain, the Netherlands, Australia). The incidence rate in Poland has still not been evaluated. It is more common in males and the incidence of peritoneal mesothelioma is 0.5–3.0 per million per year in males, and 0.2–2.0 per million per year in females. The main risk factor associated with all forms of mesothelioma is asbestos exposure [5, 6]. Other risk factors are radiation, erionite or mica exposure, talc, as well as patients suffering from familial Mediterranean fever and diffuse lymphocytic lymphoma [7–9]. Literature review shows that only 50% of patients with recognised peritoneal mesothelioma have a history of asbestos exposure [10].
A 74-year-old man with a background of ischaemic heart disease, diabetes, and hypertension was admitted to the Department of General Surgery in June because of fullness in the upper abdomen and its associated recurring pain, one week emesis after meals, weakness, and weight loss of about 15 kg during the last month. Initial clinical examination and blood examinations revealed malnutrition only. A chest X-ray did not suggest any abnormalities. An ultrasonographic examination showed low rate ascites and extended small bowel especially in the left upper quadrant. On 15 June 2015 a colonoscopy was performed. This showed three hyperplastic polyps of the sigmoid colon without any other pathologic mass, but his general condition did not improve and emesis persisted. Further imaging studies, an abdominal X-ray with barite (Figure 1), and computed tomography (CT) of the abdomen (Figure 2) revealed the presence of a pathologic infiltrating mass that measured about 40 mm and was located in the proximal part of the small bowel in the left lower quadrant. Moreover, omental involvement and subtle signs of ascites were seen. The patient was qualified for surgical treatment after appropriate preparation (total parenteral nutrition was initiated before operation). On 24 June 2015 he underwent a partial resection of the small bowel with a tumour closing almost totally a lumen of the bowel...


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