S2839 A Rare Cause of Ascites and Abdominal Pain

• DOI: 10.14309/01.ajg.0000713404.90734.62
• Publication Date: 2020-10-24T06:26:39Z
• Authors: Scarlett Cao; Patrick Mellors; Jennifer Kleinman...
• Keywords: 03 medical and health sciences; 0302 clinical medicine

INTRODUCTION: Malignant peritoneal mesothelioma (MPM) is a rare cause of ascites that can be difficult to diagnose due nonspecific clinical presentation and other diagnostic challenges. MPM often diagnosed at advanced stages leading poor prognosis high mortality rate. We describe the case man presenting with chronic abdominal pain typifies this challenging diagnosis. CASE DESCRIPTION/METHODS: 48 year-old male past medical history prior alcohol use asbestos exposure presented an 18-month progressive right upper quadrant pain, acutely worsening over last few days. He had several previous hospitalizations outside facilities for imaging showing omental nodularity exudative unclear etiology. Previous ascitic fluid cytology was negative, endoscopy colonoscopy were normal. recently started long-term trial steroids non-specific intra-abdominal inflammation. Vital signs normal exam notable only diffuse tenderness without peritonitis. Laboratory testing revealed elevated leukocyte count 14.3, otherwise CBC, hepatic function panel, CRP, INR CT abdomen showed stranding ascites. Pathology from CT-guided core biopsy enhancing nodule malignant mesothelioma, epithelioid type. chest mild pleural thickening, however negative lung involvement. underwent robotic total omentectomy post-surgical hyperthermic intraperitoneal chemotherapy (HIPEC) cisplatin 7 weeks-post hospitalization complications. DISCUSSION: This highlights challenges MPM. form linked industrial mineral exposures such as asbestos. Clinical commonly includes distension, less frequently weight loss early satiety. Serum has limited utility. shows heterogenous soft tissue mass on peritoneum. Definitive diagnosis relies direct sampling, cytologic analysis low yield. Treatment resection tumor accompanied by chemotherapy. Diagnosis delayed requires degree suspicion in context risk factors development GI symptoms.