Naraynsingh Vijay, Ramdass Michael J, Lum Crystal Lee
Department of Surgery, General Hospital, Port of Spain, Charlotte Street, Port-of-Spain, Trinidad, West Indies.
J Med Case Rep. 2011 Aug 30;5:420. doi: 10.1186/1752-1947-5-420.
Malignant peritoneal mesothelioma is a well-described entity in many reports in the literature in which it has been associated with asbestosis. However, there is no information describing the gross appearance and cardinal features seen during laparotomy, hence it is easy for the unwary surgeon to miss the diagnosis of this rare condition.
A 49-year-old man of African descent presented to our hospital with a three-month history of weight loss, anorexia, abdominal distension, and general signs of cachexia and ascites on second presentation. At first presentation one year prior to this, he had undergone a laparotomy at our institution by a different team for intestinal obstruction secondary to adhesions with no biopsy taken. The patient's condition subsequently progressively deteriorated, and investigations including upper and lower gastrointestinal endoscopies and computed tomography of the abdomen were inconclusive, except for some free fluid in the peritoneal cavity and diffuse, mild thickening of the gut wall and mesentery. A second-look exploratory laparotomy revealed widespread nodular thickening of the visceral peritoneum with a striking, uniformly diffuse, erythematous, and velvety appearance. The peritoneal biopsy histology showed that the patient had malignant peritoneal mesothelioma. His condition deteriorated rapidly, and he died eight weeks after surgery.
Our report aims to increase the diagnosing clinician's awareness of the cardinal features of malignant peritoneal mesothelioma and thus reduce diagnostic errors and delays in treatment.
恶性腹膜间皮瘤在许多文献报道中已有详细描述，且一直被认为与石棉沉着病有关。然而，目前尚无关于剖腹手术中所见大体外观和主要特征的描述，因此粗心的外科医生很容易漏诊这种罕见疾病。
一名49岁的非洲裔男子因体重减轻、厌食、腹胀以及第二次就诊时出现恶病质和腹水的一般体征，前来我院就诊。在此次就诊的一年前，他因粘连性肠梗阻在我院由另一团队进行了剖腹手术，但未进行活检。患者病情随后逐渐恶化，包括上下消化道内镜检查和腹部计算机断层扫描在内的各项检查均无定论，仅发现腹腔内有一些游离液体，肠壁和肠系膜弥漫性轻度增厚。再次剖腹探查发现脏腹膜广泛结节状增厚，外观显著、均匀弥漫、呈红斑状且似天鹅绒。腹膜活检组织学检查显示该患者患有恶性腹膜间皮瘤。他的病情迅速恶化，术后八周死亡。
我们的报告旨在提高临床诊断医生对恶性腹膜间皮瘤主要特征的认识，从而减少诊断错误和治疗延误。
