The Malignant Peritoneum Mesothelioma Discovered by the Acute Abdomen

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Abridged version : An 84-year-old woman with suspected sigmoid colon volvulus was transferred by an ambulance from a nearby hospital to our hospital. A large intestine endoscope was used to release the torsion but because it did not work. Then the patient underwent an emergency operation. Surgical examination did not reveal volvulus of sigmoid colon. Greater omentum was found to adhere to transverse colon, while stenosis and perforation was observed. Her symptom was judged as colon stenosis and perforation caused by a malignant disease. Colectomy was performed and an artificial anus was created at appendix and descending colon. The result of immunostaining was as follows : Calretinin(+), HBME-1(+), EMA(+) and CEA(-), which diagnosed her with malignant mesothelioma. History taking revealed no exposure to asbestos. Obvious pleural thickening was not observed by chest CT scan. The onset frequency of malignant mesothelioma is about 0.2% of all malignant mesothelioma, out of which about 20% develop at peritoneum. It lacks in specific manifestations and causes ascites retention in many cases, but the proper diagnosis rate by cytologic diagnosis is low. Therefore, tissue biopsy is the last diagnostic method. Now we report a case of peritoneum malignant mesothelioma, with a few bibliographic considerations, which was detected in an emergency surgery for abdominal bloating and acute abdomen.
日本外科系連合学会の論文