Acute mechanical intestinal obstruction due to lung cancer metastasis

Background

Acute mechanical small bowel obstruction is commonly caused by intraabdominal adhesions and various pathological processes such as malignancy or inflammatory bowel disease. It can also be the result of a metastatic disease such as lung cancer.

Case presentation

In this report, we present the case of a 57-year-old male patient who presented to the emergency room with epigastric pain, vomiting, and absent passage of stool or flatus. The work-up of the patient revealed a 3-cm obstructive tumor within the wall of the distal jejunum. The pathological result was consistent with squamous cell carcinoma of the jejunum, and this was believed to be a metastasis of the primary cancer of the lung since patient’s thoracic CT revealed a mass surrounding the right main bronchus.

Discussion

Metastasis to the small bowel is rare and often indicates an advanced stage of disease since the condition often goes undiagnosed. Patients may present with symptoms due to ileus such as nausea, vomiting, and abdominal pain, or due to bleeding such as hematochezia or melena. The work-up of the patient should include CT and thorough history taking should be accomplished to rule out metastasis.

Conclusion

Patients presenting with small bowel metastasis from primary lung cancer often present with severe complications such as perforation, hemorrhage, or obstruction, since the diagnosis is delayed. Metastasis should be included in the differential diagnosis in patients presenting with acute mechanical bowel obstruction and the work-up should include CT of the thorax, abdomen, and pelvis to rule out primary tumor.