Spontaneous urinary bladder perforation: An unusual presentation of well-differentiated papillary peritoneum mesothelioma

Abstract

Introduction: Well-differentiated papillary mesothelioma (WDPM) is a very rare neoplasm. Most of WDPM are asymptomatic and are often incidentally detected during surgery. This report describes a case of WDPM of the peritoneum unexpectedly diagnosed in a male with a spontaneous intraperitoneal bladder rupture.

Case presentation: A 65-year-old male presented to our Emergency Department in November 2019 with a two-day history of anuria, abdominal pain, distention, and sepsis. The CT scan reported a large amount of extra and intraperitoneal free fluid. The CT cystogram showed bladder perforations on the dome and on the left lateral wall which was repaired through exploratory laparotomy. Intraoperatively, we encountered extensive suppurative peritonitis with large fibrino-purulent exudation. The purulent perivesical peritoneum was dissected and sent for histopathological examination which unexpectedly resulted in WDPM of the peritoneum.

Conclusion: Although we can't affirm with certainty, this case would seem to suggest that WDPM had played a role in patient's clinical presentation. However, further research is necessary to draw stronger conclusion.

Keywords: Male; laparotomy; mesothelioma; peritoneum; urinary bladder disease.