A 36-year-old woman with no relevant medical history was hospitalized for peritonitis of unknown origin.
She presented with abdominal pain of 7 days duration associated with abdominal distension, nausea and vomiting.
Blood pressure was 131/76, heart rate was 126 x' and rectal temperature was 38.9°C.
The abdomen was distended, mattress was fixed and there was no bowel sounds on auscultation.
Gynecologic evaluation was normal and ultrasound revealed free intraperitoneal fluid and cystic structure adjacent to the small intestine.
Abdominal computed tomography (CT) showed some loops of small intestine surrounding a cystic tubular structure and peritoneal free fluid.
Laboratory tests revealed leukocytosis of 25,700 x mm3 and C-reactive protein of 356.06 mg/dl. With the diagnosis of complicated intestinal cystic tumor the patient was operated.
The abdominal cavity was filled with serous fluid from which samples were taken for cytology and culture.
The exploration revealed multiple tumoral implants in the parietal and visceral peritoneum, and extensive tumoral implantation of the greater omentum, samples of these implants were taken for biopsy.
A tubular cystic tumor surrounded by intestinal loops was found in the mesentery of the ileum, measuring 12 cm in diameter and 15 cm in length.
The tumor was opened and a dark, thick liquid was aspirated and sent for cytology.
The largest possible amount of tumor wall was resected leaving a part adhered to the mesentery. Complete resection of the tumor was not possible due to peritoneal dissemination and its location in the mesentery of the ileum.
Postoperative recovery was satisfactory and without complications.
However, thirty-four days later the patient died.
Cytological samples taken from peritoneal fluid and tumor content were positive for leukocytes.
Histopathology of the tumor demonstrated the presence of typical architecture of the intestinal wall, in which well-organized circular and longitudinal smooth muscle layers were recognized, identifying myenteric nervous plexuses between both muscle layers.
The internal surface was lined by an adenoid mucosecrecretory carcinoma moderately differentiated which contained all the thickness of the wall in several parts and which spread superficially through the serosa.
Intraoperative findings and histopathology confirmed the diagnosis of adenocarcinoma in an intestinal duplication of an adult patient.
