A CASE OF PERITONEAL MESOTHELIOMA WITH SMALL INTESTINAL PERFORATION DUE TO DISSEMINATION

Abstract

We report a case of peritoneal mesothelioma with small intestinal perforation. The patient was a 64-year-old man admitted to our department because of right lower abdominal pain. Previously, he had been diagnosed as having asbestosis. The patient had rebound tenderness on physical examination and free air shadow under the bilateral diaphragma was revealed by chest X-ray examination. We performed emergency laparotomy under a tentative diagnosis of generalized peritonitis due to intestinal perforation. We detected a 5cm primary tumor under the right diaphragm, the peritoneum showed extensively scattered numerous nodules less than 2cm, and a perforating metastatic tumor on the ileum located 20cm from Bauhin's valve. We performed partial resection of the ileum and reconstruction by end-to-end anastomosis. Postoperative histopathological findings revealed that the tumor of the ileum was a peritoneal mesothelioma and the central necrosis in the tumor was perforated. Histological confirmation can be achieved by immunohistochemical study with colloid-Fe. Perforated small intestinal tumor leading to peritoneal dissemination of mesothelioma is not a common disease. However, it should be taken into consideration in the differential diagnosis of other diseases caused by generalized peritonitis.