Letter to the Editor
Jejunal Perforation by Metastasis of Malignant Pleural Mesothelioma
Perforación yeyunal por metástasis de mesotelioma pleural maligno
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, Spain
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of Malignant Pleural Mesothelioma" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "366" "paginaFinal" => "367" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Inmaculada Navarro García, Ainhoa Sánchez Pérez, José Luis Vázquez Rojas" "autores" => array:3 [ 0 => array:4 [ "nombre" => "María Inmaculada" "apellidos" => "Navarro García" "email" => array:1 [ 0 => "macu844@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ainhoa" "apellidos" => "Sánchez Pérez" ] 2 => array:2 [ "nombre" => "José Luis" "apellidos" => "Vázquez Rojas" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perforación yeyunal por metástasis de mesotelioma pleural maligno" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 610 "Ancho" => 1350 "Tamanyo" => 128346 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography: thickening of a segment of the small intestinal wall (jejunum), inflammatory changes, and adjacent extraluminal air bubbles.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Malignant pleural mesothelioma is an aggressive form of cancer that originates in the pleural mesothelioma. The main pathogenic factor is exposure to asbestos. Histologically, it is classified as epithelioid (60%), biphasic (30%) or sarcomatoid (10%). It generally appears as local disease in the affected hemithorax, and metastases are rare. It is unusual for malignant pleural mesothelioma to manifest with gastrointestinal complications due to metastatic implants. We report a case of jejunal perforation due to malignant epithelioid pleural mesothelioma metastasis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 67-year-old man with a history of malignant pleural mesothelioma (T3N2M0) underwent radical pleuropulmonectomy with lymphadenectomy in July 2010. Adjuvant chemotherapy was administered and the patient was followed up by the Oncology department. He presented in the emergency room in August 2011 with a 4-h history of sudden onset abdominal pain, initially in the lower abdomen, but which then became diffuse. On examination, abdominal guarding with signs of peritoneal irritation were observed. Clinical laboratory test results were within normal limits. No significant findings were detected on abdominal X-ray. An abdominal computed tomography with intravenous contrast medium was performed, revealing air in the peritoneal cavity, circumferential wall thickening of a short segment of the hypogastric small intestine (jejunum) with marked inflammatory changes and small adjacent air bubbles (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In view of these findings, emergency laparoscopic intervention with supra and infra-umbilical access was performed, revealing acute purulent peritonitis in the inframesocolic space due to a single perforation of the jejunum at the site of an ischemic lesion. Intestinal resection with manual end-to-end anastomosis was performed and the post-operative period was incident-free. Pathology reported epithelioid malignant mesothelioma metastasis in the intestinal wall and 2 isolated lymph nodes. The patient was referred to the oncology department for treatment with chemotherapy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">A search of the Medline database (1974–2013) retrieved 4 cases of malignant pleural mesothelioma metastasis involving the small intestine<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–4</span></a> and 1 case presenting as acute jejunal perforation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Our patient is the second case with acute presentation described in the literature. Malignant pleural mesothelioma generally manifests as a locally invasive chest tumor, while cases of gastrointestinal metastases are rare, probably because diagnosis is difficult. Abdominal symptoms tend to be unspecific and are often interpreted as side effects of chemotherapy, and the sensitivity of ultrasound and computed tomography (CT) techniques for detecting intestinal tumors is poor. PET/CT and the combination of capsule endoscopy and double-balloon enteroscopy may overcome difficulties in detecting this type of metastatic implant.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In our opinion, the possibility of metastasis to the small intestine must be taken into account in patients with a history of malignant pleural mesothelioma and clinical symptoms consisting of acute abdominal pain, occult fecal blood, and intermittent unspecific abdominal pain.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleGrantSponsor" id="gs1">Servicio de Cirugía General</span> y <span class="elsevierStyleGrantSponsor" id="gs2">Aparato Digestivo del Hospital Universitario Santa Lucia de Cartagena</span>.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discussion" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Navarro García MI, Sánchez Pérez A, Vázquez Rojas JL. Perforación yeyunal por metástasis de mesotelioma pleural maligno. Arch Bronconeumol. 2015;51:366–367.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 610 "Ancho" => 1350 "Tamanyo" => 128346 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography: thickening of a segment of the small intestinal wall (jejunum), inflammatory changes, and adjacent extraluminal air bubbles.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "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" => "bib0035" "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" => "bib0040" "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. Tsuta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2007-966561" "Revista" => array:7 [ "tituloSerie" => "Endoscopy" "fecha" => "2007" "volumen" => "39" "numero" => "Suppl. 1" "paginaInicial" => "E229" "paginaFinal" => "E230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17674287" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple bowel intussusceptions from metastatic localized malignant pleural mesothelioma: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. Liu" 1 => "Y.-J. Cheng" 2 => "H.-P. Chen" 3 => "J.-C. Hwang" 4 => "P.-C. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "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" ] ] "itemHostRev" => array:3 [ "pii" => "S0022534707031308" "estado" => "S300" "issn" => "00225347" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "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:7 [ "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" ] ] "itemHostRev" => array:3 [ "pii" => "S0090429508006523" "estado" => "S300" "issn" => "00904295" ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgements" "texto" => "<p id="par0030" class="elsevierStylePara elsevierViewall">Servicio de Cirugía General y Aparato Digestivo del Hospital Universitario Santa Lucia de Cartagena.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000007/v1_201506250123/S1579212915001184/v1_201506250123/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000007/v1_201506250123/S1579212915001184/v1_201506250123/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915001184?idApp=UINPBA00003Z" ]
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| 2021 November | 34 | 37 | 71 |
| 2021 October | 39 | 38 | 77 |
| 2021 September | 32 | 40 | 72 |
| 2021 August | 27 | 27 | 54 |
| 2021 July | 23 | 23 | 46 |
| 2021 June | 25 | 31 | 56 |
| 2021 May | 33 | 26 | 59 |
| 2021 April | 66 | 67 | 133 |
| 2021 March | 46 | 19 | 65 |
| 2021 February | 27 | 20 | 47 |
| 2021 January | 23 | 19 | 42 |
| 2020 December | 25 | 15 | 40 |
| 2020 November | 15 | 18 | 33 |
| 2020 October | 13 | 15 | 28 |
| 2020 September | 18 | 8 | 26 |
| 2020 August | 31 | 14 | 45 |
| 2020 July | 23 | 19 | 42 |
| 2020 June | 19 | 6 | 25 |
| 2020 May | 18 | 17 | 35 |
| 2020 April | 27 | 22 | 49 |
| 2020 March | 27 | 14 | 41 |
| 2020 February | 30 | 25 | 55 |
| 2020 January | 29 | 19 | 48 |
| 2019 December | 30 | 15 | 45 |
| 2019 November | 36 | 30 | 66 |
| 2019 October | 14 | 11 | 25 |
| 2019 September | 28 | 14 | 42 |
| 2019 August | 26 | 15 | 41 |
| 2019 July | 31 | 17 | 48 |
| 2019 June | 27 | 20 | 47 |
| 2019 May | 29 | 9 | 38 |
| 2019 April | 27 | 37 | 64 |
| 2019 March | 43 | 20 | 63 |
| 2019 February | 29 | 13 | 42 |
| 2019 January | 31 | 11 | 42 |
| 2018 December | 89 | 18 | 107 |
| 2018 November | 80 | 22 | 102 |
| 2018 October | 64 | 23 | 87 |
| 2018 September | 29 | 12 | 41 |
| 2018 May | 23 | 0 | 23 |
| 2018 April | 38 | 2 | 40 |
| 2018 March | 69 | 7 | 76 |
| 2018 February | 37 | 3 | 40 |
| 2018 January | 79 | 8 | 87 |
| 2017 December | 62 | 5 | 67 |
| 2017 November | 18 | 5 | 23 |
| 2017 October | 13 | 5 | 18 |
| 2017 September | 18 | 13 | 31 |
| 2017 August | 20 | 14 | 34 |
| 2017 July | 15 | 6 | 21 |
| 2017 June | 34 | 14 | 48 |
| 2017 May | 25 | 15 | 40 |
| 2017 April | 24 | 8 | 32 |
| 2017 March | 26 | 15 | 41 |
| 2017 February | 22 | 4 | 26 |
| 2017 January | 22 | 8 | 30 |
| 2016 December | 27 | 8 | 35 |
| 2016 November | 48 | 16 | 64 |
| 2016 October | 49 | 14 | 63 |
| 2016 September | 39 | 17 | 56 |
| 2016 August | 37 | 11 | 48 |
| 2016 July | 19 | 12 | 31 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 November | 1 | 8 | 9 |
| 2015 October | 36 | 1 | 37 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 0 | 1 | 1 |
Show all
