Cipollone G, Montini F, Lattanzio G, Errichi B M
Istituto di Clinica Chirurgica, Università degli Studi di Chieti.
Chir Ital. 1994;46(6):73-9.
Peritoneal mesothelioma is a rare neoplasm with generic and non-specific symptoms. In some cases it is associated with various and particular clinical syndromes. These findings make it so insidious that the diagnosis is rarely make the preoperative course. Usually, there has been previous exposure to asbestos, during even if other causes are reported. Rarely, a peritoneal mesothelioma appears with signs and symptoms suggestive of acute abdomen, such as the present case. On admission the patient presented clinical features apparently requiring emergency surgery. In fact, at laparotomy, the tumour, arising from the mesenterium, had perforated the peritoneal cavity and communicated with the digiunal lumen, causing a septic hemoperitoneum. A radical resection was performed and the continuity of the intestinal tract was restored through an end-to-end entero-anastomosis. The patient, with a history of exposure to asbestos, was alive four years later. But over the last twelve months diffuse metastasis has occurred in the lung and liver, and there was no response to systemic chemotherapy. This case may be considered singular of the clinical syndrome, the long-term survival and the circumscribed aspect of the tumour. Through a review of the literature, the features of the present diagnostic procedure are underlined and the importance of multidisciplinary treatment as the best approach to peritoneal mesothelioma is emphasized.
腹膜间皮瘤是一种罕见的肿瘤，症状一般且不具特异性。在某些情况下，它与各种特殊的临床综合征相关。这些表现使其极具隐匿性，以至于术前很少能做出诊断。通常，患者既往有石棉接触史，即便也有其他病因的报道。极少情况下，腹膜间皮瘤会以急腹症的体征和症状出现，如本病例。入院时患者的临床特征明显需要急诊手术。事实上，剖腹探查时发现，起源于肠系膜的肿瘤已穿破腹膜腔并与十二指肠腔相通，导致感染性血腹。进行了根治性切除，并通过端端肠吻合术恢复了肠道的连续性。该患者有石棉接触史，四年后仍存活。但在过去十二个月里，肺部和肝脏出现了弥漫性转移，且全身化疗无效。该病例在临床综合征、长期生存以及肿瘤的局限性方面可能被视为独特。通过文献回顾，强调了当前诊断程序的特点，并强调多学科治疗作为腹膜间皮瘤最佳治疗方法的重要性。
