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[Bowel perforation due to metastatic lung cancer: a case report].

We report a case of small bowel perforation secondary to metastasis from a lung squamous cell carcinoma that occurred in a 72-year-old man. He was admitted to the hospital because of remittant hemoptysis after undergoing a right upper lobectomy. Fiberoptic bronchoscopy revealed bleeding from the right upper lobe bronchial stump that was due to recurrence of the tumor. He developed abdominal pain, nausea and vomiting four months after resection of the primary tumor. An abdominal radiograph demonstrated free air in the abdominal cavity. He was diagnosed as having intestinal perforation and was operated on. The operative findings indicated adherence and perforation of the jejunum and ileum. The pathological diagnosis of the removed tumor was poorly differentiated squamous cell carcinoma. The patient died 32 days after the second operation. Although abdominal metastasis from lung cancer is not an unusual postmortem finding, it is rare in clinical situations. If a patient with lung cancer complains of abdominal pain, it is important to consider the possibility of abdominal metastasis.

Abdominal Pain↗

Intestinal metastases from renal cell carcinoma: a rare cause of intestinal obstruction and bleeding.

Intestinal metastases from renal cell carcinoma (RCC) are rare. Clinical presentation includes intestinal obstruction, bleeding, or perforation. Management should be aggressive, since the prognosis of RCC is unpredictable and metastasectomy can extend patient survival. We present a patient with intestinal obstruction and bleeding caused by intestinal metastases from renal cell carcinoma and summarize the surgical procedures employed. The relevant literature is briefly reviewed.

Aged↗

[Synchronous and metachronous carcinomas of the large intestine].

The authors present their experience relative to 5 patients with multiple carcinomas (synchronous and metachronous) of the large bowel. They underline that full examination of the colon before operation in all patients with primary colorectal cancer is necessary, and they propose a lifelong follow-up program after resection for early detection of multiple carcinomas.

Carcinoma↗

[Small bowel metastases from lung cancer].

Lung cancer is usually diagnosed at an advanced stage and metastases are present in 50% of patients. Small bowel metastases from lung cancer are rare, being more frequent in patients with melanoma, uterine, ovarian, kidney or gastrointestinal cancer, or osteosarcoma. From November 1998 to August 2003, 740 cases of lung cancer (641 non-small-cell lung cancer and 99 neuroendocrine tumours) were diagnosed. We also observed 64 patients with malignant pleural mesothelioma and performed 23 pleuropneumonectomies. Over the same period we admitted 4 patients (one recurrent) with small bowel metastases, three from lung cancer and one from malignant mesothelioma. The clinical symptoms were bowel occlusion and intestinal bleeding. Radiological techniques such as small bowel enema and CT enteroclysis were used with positive results. In one patient with intestinal bleeding capsular endoscopy revealed a bleeding metastasis. All patients were operated on. Neither mortality nor morbidity were observed. All patients were discharged after a median stay of 10 days. One patient is still alive and disease-free 39 months after the first intestinal surgery for metastases. Intestinal metastases from lung cancer are rare and the diagnosis is often late. In some cases the clinical manifestations of the metastases are observed before those of the primitive tumour. However, in the presence of small bowel occlusion and intestinal bleeding of uncertain origin, clinical history-taking is very important and diagnostic procedures must be performed to exclude a secondary pathology.

Aged↗

[A case of primary cancer of the small intestine].

We experienced the case that used S-1 for small intestinal cancer with peritoneal dissemination. A 51-year-old man admitted for fatigability and anemia. Small bowel series showed a stenosis lesion at the 15cm anal side from Treiz ligament, and the oral intestinal dilatasion was shown. CT showed the thickening of small intestinal wall and rectal wall. In addition, a rectal stenosis was shown by barium enema. It was diagnosed as small intestinal cancer with peritoneal dissemination, and an operation was performed. Peritoneal dissemination was recognized in the intraperitoneal whole, so jejunum partial resection was performed for primary cancer lesion. After an operation, internal use of S-1 was performed in an outpatient department. One course was assumed administration for four weeks and withdrawal for two weeks, and three courses was performed. There was not a side effect, and barium enema showed improvement of a rectal stenosis, and CT showed improvement of thickening of a rectal wall. A lesion worsened afterwards, and he died in postoperative six months.

Adenocarcinoma↗

[A case of recurrent GIST successfully treated with low-dose imatinib mesilate].

A 75-year-old man underwent partial resection of the small intestine for GIST in January 2000. A recurrent tumor revealed in the intra pelvic space was removed by two operations, and imatinib (400 mg/day) was given after the third operation. As successive administration was not able to be continued due to side effects such as anorexia and fatigue, the recurrent tumor enlarged. After imatinib was given at 200 mg/day, the defecation trouble was improved and the tumor decreased partially on CT image. His partial response has continued over one year. Mutation analysis revealed deletion and point mutation in exon 11 of c-kit gene. Low-dose imatinib administration should be considered in case of side effects at the standard dose.

Aged↗

[Resection of carcinoid tumors of the small intestine is still indicated in the presence of disseminated hepatic metastases].

The authors report their experience with resection of small bowel carcinoid tumors associated with diffuse hepatic metastases. Nine patients were operated during the last ten years. A carcinoid syndrome was present biologically in every case and clinically in 8 cases. The tumor was removed in every case, either by right hemicolectomy (n = 6), or by small bowel resection (n = 3). Postoperative mortality and morbidity were nil. Adjuvant therapy included hepatic chemo-embolization and long-term therapy by a long-acting somatostatin analog. Five patients died during the period of follow-up and 4 patients were alive at the end of the study. Resection of small bowel carcinoid tumor is indicated even when the liver is involved by diffuse metastases to prevent the risk of small bowel occlusion, and to promote hepatic chemoembolization as subsequent therapy against the carcinoid syndrome and metastatic spread. Moreover, the procedure can participate in the selection of cases for orthotopic liver transplantation, when conservative therapy fails to control the carcinoid syndrome.

Aged↗

[A case of perforation of the metastatic site of lung carcinoma in the small bowel].

Metastasis of lung carcinoma in the small bowel is so extremely rare as there were 53 cases in total with small bowel metastasis from lung carcinoma reported in the past literature. A case of a 72-year-old man with unresectable lung carcinoma (squamous cell carcinoma) was reported, he had an acute perforation of the small bowel following intensive course of irradiation therapy for primary site. Emergency operation was performed, but he died of DIC (disseminated intravascular coagulation) 3 days after surgery.

Aged↗