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. 2019 Apr;17(4):3862-3866.
doi: 10.3892/ol.2019.10031. Epub 2019 Feb 12.

Small bowel perforation with multiple intestinal metastases from lung carcinoma: A case report

Evangelos P Misiakos  1 , Alina-Roxani Gouloumi  2 , Dimitrios Schizas  3 , Vasileia Damaskou  2 , Dimitrios Tsapralis  4 , Frederick-Anthony Farrugia  1 , Nikolaos Machairas  1 , Dimitrios Papaconstantinou  1 , Ariadni Tzaneti  1 , Anastasios Machairas  1
Affiliations

Small bowel perforation with multiple intestinal metastases from lung carcinoma: A case report

Evangelos P Misiakos et al. Oncol Lett. 2019 Apr.

Abstract

The present report describes the case of an 81-year-old woman who underwent an emergency explorative laparotomy due to small bowel perforation. Diffuse feculent peritonitis due to perforation of the jejunum was identified. In addition, six distinct tumors of the jejunum in close proximity to the perforation site, as well as two more lesions caudally at the ileum, were identified. A separate stenotic tumor was identified at the sigmoid colon, causing moderate dilatation of the whole intestine. An enterectomy, including the perforation site and the proximal six tumors, was performed, followed by limited enterectomies for the distal two tumors and side-to-side anastomoses of the small intestine. All resected tumors were identified at histology as metastatic from lung carcinoma. Postoperatively, the patient remained in a severe septic condition and succumbed the following day. Metastatic lesions from lung carcinoma in the small bowel wall are a rare finding predisposing to bowel perforation. When an acute condition coexists with multiple intestinal metastases, the mortality rate is high despite prompt surgical intervention.

Keywords: carcinoma; gastrointestinal neoplasms; lung; metastasis; perforation; small bowel.

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Figures

Figure 1.
Figure 1.
Abdominal computed tomography (coronal view) demonstrating a large metastatic tumor occupying a significant part of the liver parenchyma, and multiple tumors in a number of loops of the small intestine (arrows) infiltrating the bowel wall.
Figure 2.
Figure 2.
Intraoperative results. (A) Perforation site in the mid-jejunum and multiple tumors (arrows) of the jejunal wall close to the perforation site. (B) Stenotic tumor at the wall of the mid-sigmoid (arrow). (C) Enterectomy including the perforation site and the proximal six tumors of the small intestine. (D) Segmental enterectomies for the two tumors at the ileum.
Figure 3.
Figure 3.
Histopathology of the resected lesions. (A) Sections demonstrated a poorly differentiated neoplasm in the small bowel submucosa (arrow) not associated with mucosal dysplasia (H&E; magnification, ×4), and (B) in the pericolic fat (H&E; magnification, ×10). (C) Tumor cells at high magnification (H&E; magnification, ×40). H&E, hematoxylin and eosin.
Figure 4.
Figure 4.
Immunohistochemical analysis of the resected specimens. (A) TTF1 positive staining (magnification, ×20) in sections from a small bowel mass, (B) pericolic fat, (C) p63 and (D) Napsin A staining was additionally positive. TTF1, thyroid transcription factor 1.
See this image and copyright information in PMC

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