Carta al Director
Perforación yeyunal por metástasis de mesotelioma pleural maligno
Jejunal Perforation by Metastasis of Malignant Pleural Mesothelioma
María Inmaculada Navarro García
, Ainhoa Sánchez Pérez, José Luis Vázquez Rojas
Corresponding author
Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España
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"cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Jejunal Perforation by Metastasis of Malignant Pleural Mesothelioma" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 610 "Ancho" => 1350 "Tamanyo" => 122802 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">TC abdominal: engrosamiento mural de un segmento de intestino delgado (yeyuno), cambios inflamatorios y burbujas de aire extraluminales adyacentes.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sr. Director:</span></p><p id="par0010" class="elsevierStylePara elsevierViewall">El mesotelioma pleural maligno es una neoplasia agresiva originada en el mesotelio pleural, siendo el asbesto el principal factor implicado en su patogénesis. Desde el punto de vista histológico, se clasifica en epitelioide (60%), bifásico (30%) y sarcomatoide (10%). Por lo general se manifiesta a nivel local en el hemitórax afecto, y su presentación como enfermedad metastásica es poco frecuente. Son raros los casos de mesotelioma pleural maligno que manifiestan complicaciones gastrointestinales secundarias a implantes metastásicos. Presentamos un caso de perforación yeyunal por metástasis de mesotelioma pleural maligno tipo epitelioide.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Varón de 67<span class="elsevierStyleHsp" style=""></span>años con antecedentes de mesotelioma pleural maligno (T3N2M0) intervenido en julio 2010, en el que se realizó una pleuroneumectomía radical con linfadenectomía, recibiendo quimioterapia adyuvante y en seguimiento por Oncología. Acude a Urgencias en agosto de 2011 por dolor abdominal de 4<span class="elsevierStyleHsp" style=""></span>h de evolución, de inicio súbito, localizado en el hipogastrio y que posteriormente se hace difuso. A la exploración presenta abdomen con defensa generalizada y signos de irritación peritoneal. La analítica está dentro de los límites de la normalidad. La radiografía de abdomen no presenta hallazgos relevantes y se realiza una TC abdominal con contraste intravenoso que informa de neumoperitoneo, engrosamiento mural circunferencial de un corto segmento de intestino delgado en hipogastrio (yeyuno) con marcados cambios inflamatorios y pequeñas burbujas de aire adyacente (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>). Ante los hallazgos se decide intervención quirúrgica urgente mediante laparotomía media supra-infraumbilical, hallando peritonitis aguda purulenta inframesocólica por perforación única de yeyuno sobre placa isquémica. Se realiza resección intestinal y anastomosis término-terminal manual. El postoperatorio fue satisfactorio, y la anatomía patológica informa de metástasis de mesotelioma maligno epitelioide en la pared intestinal y en 2 ganglios aislados. El paciente fue remitido a Oncología, iniciando tratamiento con quimioterapia.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discusión</span><p id="par0020" class="elsevierStylePara elsevierViewall">Hemos revisado la bibliografía en Medline (1974-2013) y encontrado 4 casos descritos de metástasis de mesotelioma pleural maligno con afectación de intestino delgado<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> y un único caso que se presenta como perforación aguda yeyunal<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. Nuestro paciente es el segundo caso descrito como presentación aguda. El mesotelioma pleural maligno suele manifestarse como un tumor localmente invasivo en el tórax, siendo muy pocos los casos de metástasis gastrointestinales, probablemente debido a su difícil diagnóstico. Se suelen interpretar los síntomas abdominales como secundarios a la quimioterapia, ya que son poco específicos y, además, la ecografía y la TC abdominal tienen baja sensibilidad para la detección de tumores intestinales. La PET-TC y la combinación de cápsula endoscópica y endoscopia de doble balón pueden ayudar a la detección de este tipo de implantes metastásicos.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Consideramos que la posibilidad de metástasis de intestino delgado debe ser tenida en cuenta en pacientes con antecedentes de mesotelioma pleural maligno y clínica compatible con dolor abdominal agudo, sangre oculta en heces y dolor abdominal intermitente, inespecífico.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financiación</span><p id="par0030" class="elsevierStylePara elsevierViewall">Servicio de Cirugía General y Aparato Digestivo del Hospital Universitario Santa Lucia de Cartagena.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discusión" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Financiación" ] 2 => array:1 [ "titulo" => "Bibliografía" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 610 "Ancho" => 1350 "Tamanyo" => 122802 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">TC abdominal: engrosamiento mural de un segmento de intestino delgado (yeyuno), cambios inflamatorios y burbujas de aire extraluminales adyacentes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Duodenal metastasis of malignant pleural mesothelioma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.C. Chen" 1 => "K.B. Tsai" 2 => "C.S. Wang" 3 => "T.J. Hsieh" 4 => "J.S. Hsu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0929-6646(09)60021-8" "Revista" => array:6 [ "tituloSerie" => "J Formos Med Assoc" "fecha" => "2008" "volumen" => "107" "paginaInicial" => "961" "paginaFinal" => "964" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19129058" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of malignant pleural mesothelioma with gastrointestinal metastases which were diagnosed by endoscopic biopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Terashita" 1 => "K. Hirano" 2 => "T. Hirai" 3 => "T. Narabayashi" 4 => "Y. Hara" 5 => "H. Mori" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nihon Kokyuki Gakkai Zasshi" "fecha" => "2009" "volumen" => "47" "paginaInicial" => "133" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19260537" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of smallbowel metastasis of malignant pleural mesothelioma by capsule endoscopy and double ballon enteroscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Kakugawa" 1 => "S. Watanabe" 2 => "N. Kobayashi" 3 => "M. Tani" 4 => "S. Tanaka" 5 => "K. 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Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "3984" "paginaFinal" => "3986" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20712062" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant pleural mesothelioma presenting as an acute surgical abdomen due to metastatic jejunal perforation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Gocho" 1 => "K. Isobe" 2 => "K. Kaburaki" 3 => "Y. Honda" 4 => "A. Mitsuda" 5 => "Y. Akasaka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intern Med" "fecha" => "2010" "volumen" => "49" "paginaInicial" => "597" "paginaFinal" => "601" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20228599" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Agradecimientos" "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">Servicio de Cirugía General y Aparato Digestivo del Hospital Universitario Santa Lucia de Cartagena.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005100000007/v2_201506280052/S0300289614001707/v2_201506280052/es/main.assets" "Apartado" => array:4 [ "identificador" => "9222" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director / Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005100000007/v2_201506280052/S0300289614001707/v2_201506280052/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614001707?idApp=UINPBA00003Z" ]
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| 2024 February | 41 | 31 | 72 |
| 2023 March | 8 | 5 | 13 |
| 2023 February | 55 | 20 | 75 |
| 2023 January | 39 | 24 | 63 |
| 2022 December | 65 | 28 | 93 |
| 2022 November | 79 | 23 | 102 |
| 2022 October | 46 | 22 | 68 |
| 2022 September | 46 | 41 | 87 |
| 2022 August | 55 | 42 | 97 |
| 2022 July | 48 | 41 | 89 |
| 2022 June | 42 | 42 | 84 |
| 2022 May | 49 | 43 | 92 |
| 2022 April | 67 | 25 | 92 |
| 2022 March | 52 | 49 | 101 |
| 2022 February | 49 | 24 | 73 |
| 2022 January | 68 | 33 | 101 |
| 2021 December | 63 | 30 | 93 |
| 2021 November | 73 | 36 | 109 |
| 2021 October | 125 | 38 | 163 |
| 2021 September | 66 | 49 | 115 |
| 2021 August | 41 | 29 | 70 |
| 2021 July | 67 | 33 | 100 |
| 2021 June | 84 | 31 | 115 |
| 2021 May | 61 | 29 | 90 |
| 2021 April | 122 | 97 | 219 |
| 2021 March | 65 | 10 | 75 |
| 2021 February | 53 | 17 | 70 |
| 2021 January | 44 | 10 | 54 |
| 2020 December | 55 | 18 | 73 |
| 2020 November | 50 | 10 | 60 |
| 2020 October | 48 | 20 | 68 |
| 2020 September | 45 | 9 | 54 |
| 2020 August | 55 | 14 | 69 |
| 2020 July | 65 | 25 | 90 |
| 2020 June | 58 | 20 | 78 |
| 2020 May | 48 | 17 | 65 |
| 2020 April | 37 | 19 | 56 |
| 2020 March | 45 | 15 | 60 |
| 2020 February | 66 | 18 | 84 |
| 2020 January | 69 | 21 | 90 |
| 2019 December | 55 | 27 | 82 |
| 2019 November | 47 | 20 | 67 |
| 2019 October | 64 | 19 | 83 |
| 2019 September | 78 | 9 | 87 |
| 2019 August | 55 | 22 | 77 |
| 2019 July | 49 | 16 | 65 |
| 2019 June | 79 | 16 | 95 |
| 2019 May | 57 | 29 | 86 |
| 2019 April | 112 | 30 | 142 |
| 2019 March | 61 | 26 | 87 |
| 2019 February | 59 | 12 | 71 |
| 2019 January | 52 | 18 | 70 |
| 2018 December | 41 | 19 | 60 |
| 2018 November | 51 | 18 | 69 |
| 2018 October | 68 | 25 | 93 |
| 2018 September | 31 | 17 | 48 |
| 2018 August | 1 | 0 | 1 |
| 2018 July | 3 | 0 | 3 |
| 2018 June | 4 | 0 | 4 |
| 2018 May | 18 | 1 | 19 |
| 2018 April | 54 | 8 | 62 |
| 2018 March | 31 | 4 | 35 |
| 2018 February | 27 | 4 | 31 |
| 2018 January | 71 | 11 | 82 |
| 2017 December | 40 | 10 | 50 |
| 2017 November | 24 | 4 | 28 |
| 2017 October | 25 | 4 | 29 |
| 2017 September | 33 | 8 | 41 |
| 2017 August | 20 | 5 | 25 |
| 2017 July | 37 | 7 | 44 |
| 2017 June | 29 | 15 | 44 |
| 2017 May | 27 | 7 | 34 |
| 2017 April | 18 | 5 | 23 |
| 2017 March | 25 | 5 | 30 |
| 2017 February | 14 | 9 | 23 |
| 2017 January | 21 | 8 | 29 |
| 2016 December | 34 | 6 | 40 |
| 2016 November | 54 | 9 | 63 |
| 2016 October | 40 | 8 | 48 |
| 2016 September | 40 | 16 | 56 |
| 2016 August | 36 | 11 | 47 |
| 2016 July | 46 | 7 | 53 |
| 2016 June | 47 | 16 | 63 |
| 2016 May | 27 | 10 | 37 |
| 2016 April | 26 | 2 | 28 |
| 2016 March | 21 | 2 | 23 |
| 2016 February | 33 | 3 | 36 |
| 2016 January | 36 | 9 | 45 |
| 2015 December | 51 | 16 | 67 |
| 2015 November | 57 | 14 | 71 |
| 2015 October | 77 | 4 | 81 |
| 2015 September | 4 | 0 | 4 |
| 2015 August | 3 | 0 | 3 |
| 2015 July | 8 | 0 | 8 |
| 2015 June | 7 | 0 | 7 |
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