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.
Introduction: Peritoneal mesothelioma is an uncommon and highly aggressive cancer that develops in the peritoneum, the membrane lining the abdominal cavity, and covering organs such as the liver and intestines. Like other forms of mesothelioma, this cancer is often associated with previous exposure to asbestos, a hazardous material that can pose health risks if inhaled or ingested. Diagnosing peritoneal mesothelioma is challenging due to its tendency to spread extensively within the abdominal lining before detection.
In the United Kingdom, approximately 2,700 people are diagnosed with mesothelioma each year, with men at a higher risk than women. Most cases occur in individuals aged 75 and older. Although there is currently no cure for mesothelioma, treatment options are available to help alleviate symptoms and improve quality of life. Peritoneal mesothelioma likely accounts for no more than 7%-10% of all mesothelioma cases, although the exact numbers are unknown. It is much less common than pleural mesotheliomas.
Peritoneal mesothelioma often presents with nonspecific symptoms, such as abdominal pain, bloating, and fluid accumulation, which cause discomfort due to pressure on surrounding organs. Other signs may include changes in bowel habits, weight loss, fever, fatigue, nausea, and night sweats, with rare cases progressing to bowel obstruction. Since symptoms typically appear 20 to 40 years after asbestos exposure and are often vague or intermittent, diagnosis is frequently delayed.
Case Presentation: In early April 2024, a 60-year-old man who had previously worked in building trades and had a history of asbestos exposure presented to the hospital with sudden, severe central abdominal pain and nausea. His past medical history included a duodenal perforation, myocardial infarction, and insulin-dependent diabetes, and he had quit smoking several years earlier with no significant family history. His occupational history included working in a building with asbestos more than 30 years ago and, more notably, in a foundry where asbestos ropes were used. These ropes were sometimes draped around workers’ necks or even held in their mouths for convenience.
The initial examination revealed abdominal guarding and signs of peritonism. Blood tests were unremarkable except for an elevated C-reactive protein (CRP) of 130 mg/dl (reference range: 0.0-5.0 mg/dl). Suspecting an acute abdominal condition, the surgical team took over his care and arranged an urgent contrast-enhanced CT scan of the abdomen and pelvis (Figures 1, 2) to rule out perforation. [Footnotes omitted]
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