Acute presentation of multi-cystic peritoneal mesothelioma

Multi-cystic peritoneal mesothelioma (MCPM) is a rare intra-abdominal neoplasm that occurs most commonly in young females. The disease usually presents as an incidental finding or with sub-acute abdominal pain. The mainstay of treatment is complete excision; however, local recurrence frequently occurs and malignant transformation has been reported. We describe a unique case of MCPM that presented with acute abdominal pain. A 32-year-old female presented with a 24-hour history of abdominal pain. Computed tomography abdomen demonstrated a low-density mass with surrounding inflammatory changes anterior to the ascending colon, which was initially thought to represent an abscess. A percutaneous drain was inserted; however, only clear fluid was aspirated and the lesion did not resolve. The patient subsequently underwent laparoscopy which identified a cystic structure overlying the ascending colon. The structure was excised whole with histology demonstrating MCPM. The patient recovered from surgery and will undergo a period of surveillance.