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Background: Malignant pleural mesothelioma is an aggressive form of cancer originating in the pleuralmesothelioma. It generally appears as a local disease in the affected hemithorax, and metastasis are rare. Itis unusual for malignant pleural mesothelioma to manifest with gastrointestinal complications due tometastatic implants, but clinicians should be careful to take into consideration this hypothesis in patientswith a history of malignant pleural mesothelioma referring to the Emergency Department with acuteabdominal pain.Case Presentation: A 65-year-old man, with a medical history of pleural mesothelioma, presented to ouremergency department for acute abdominal pain. The patient underwent abdominal ultrasound andabdominal Computed Tomography with intravenous contrast. At US examination a small bowel obstructiondiagnosis was made, CT confirmed a mechanical small bowel obstruction due to an intussusceptedmultiloculated mass in the terminal ileum, with CT’s signs of parietal damage; another peritoneal mass wasreported adjacent to the posterior wall of the cecum and in contiguity with the iliopsoas muscle. Consideringthe acute medical presentation, the patient underwent surgery, with segmental bowel resection and a stapledside-by-side bowel anastomosis. Histopathology revealed metastasis of sarcomatoid pleural mesothelioma.The post-operative course was complicated by anastomotic leak treated with a conservative approach. Thepatient was discharged on the 24th post-operative day.Conclusion: Our case highlights the potential of pleural mesothelioma to metastasize within abdominalviscera, causing bowel obstruction. In presence of the patient’s critical clinical condition and advanced stateof local disease, a surgical approach based on damage control procedure consisting in exploration, biopsiesand ileostomy upstream the obstruction or, exploration and resection without anastomosis, carry on severaladvantages, solving the acute clinical condition, staging the disease and offering the possibility to proceedrapidly with supportive care (chemotherapy and/or surgery).

A Surprising Finding of Ileal Intussusception Caused by Pleural Mesothelioma Metastases