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Renal cell carcinoma (RCC) accounts for approximately 3% of all adult malignancies. True gastrointestinal metastases, specifically to gastric wall, have been rarely observed. Herein we describe a case of delayed metastasis to gastric wall occurring more than a decade after previously curative nephrectomy for RCC. A 67-year-old male with history of right radical nephrectomy in 2001 for RCC was found to have an asymptomatic right lower lobe solitary lung mass upon routine follow-up in 2011, with final biopsy results showing metastatic RCC for which he was treated accordingly. In 2014, patient was evaluated for dyspepsia with microcytic anemia and underwent an esophagogastroduodenoscopy and colonoscopy. EGD revealed a solitary one-centimeter atypical ulcer in the posterior mid gastric body with biopsy results being consistent with metastatic RCC. Our literature review has yielded thirty-six reported cases of RCC in association with gastric wall metastases.

Summary:Fistula formation between the duodenum and the skin of the anterior abdominal wall is a rare complication of duodenal ulcer disease, most often felt to occur following ulcer surgery. The development of a spontaneous duodenocutaneous fistula in association with duodenal ulcer has not been hitherto reported. A middle aged man with a history of peptic ulcer for more than 10 years, and a vagotomy and pyloroplasty 15 months earlier, presented with an asymptomatic duodenocutaneous fistula, presumably secondary to a perforated duodenal bulb ulcer. Successful healing of the fistula was accomplished by non-surgical therapy consisting of nasogastric suction, intravenous alimentation and parenteral cimetidine over a 4-week period.