Metastatic Small Bowel Tumor from Descending Colon Cancer with Extensive Hematogenous or Lymphogenous Spread: Survey of the Japanese Literature

Kojima, Yutaka; Matsumoto, Fumio; Mikami, Yuko; Namekata, Koji; Takei, Masahiko

doi:10.1159/000320649

Cited by 11 publications

(20 citation statements)

References 3 publications

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“…Although radical surgical resection of such late colorectal metastasis is reportedly associated with a good quality of life, postoperative complication rates are considered to be high, at approaching 80%, and survival is short (ranging from 2-15 months), 2 although survival of up to 11 years has been reported. 4 This case lends support to this unfavourable picture, as our patient experienced a number of serious postoperative complications, including intraabdominal bleeding, cardiac infarction and enetrocutaneous fistula.…”

Section: Discussionsupporting

confidence: 64%

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Late metastatic colon cancer masquerading as primary jejunal carcinoma

Meshikhes

Joudeh

2016

annals

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Metastasis to the small bowel from a previously resected colorectal cancer is rare and may erroneously be diagnosed as a primary small bowel carcinoma. It usually occurs several years after the primary resection. We present the case of a 67-year-old man who had undergone left hemicolectomy for colon cancer 3 years earlier and returned with subacute small bowel obstruction. This was initially thought, based on preoperative radiological findings and normal colonoscopic examination, to be due a primary jejunal cancer. Even at surgery, the lesion convincingly appeared as an obstructing primary small bowel carcinoma. However, the histology of the resected small bowel revealed metastatic colon cancer. This rare and an unusual metastatic occurrence some years after the primary resection is described and reviewed. While small bowel cancer is rare, it may occur in patients who were previously diagnosed and surgically treated for colorectal carcinoma (CRC).1 This late metastasis may occur at distant and unusual sites, and be diagnosed erroneously as a primary small bowel carcinoma.We present a case of subacute small bowel obstruction in an older male patient who had undergone left hemicolectomy for colon cancer 3 years earlier. Case reportA 67-year-old man presented with 3-month history of colicky left-sided abdominal pain, which was associated with nausea, abdominal distension and constipation. He tolerated only a liquid diet only and had lost some weight. He underwent coronary artery bypass graft 10 years previously, as well as an emergency Hartman procedure for obstructing left colon cancer (T3,N0,Tx) 3 years earlier. This was followed by its reversal 3 months later. He received neither adjuvant chemotherapy nor receiving antiplatelet therapy. Prior to his referral, he underwent colonoscopy, which was reported as normal. Generally, he appeared in reasonable health, and abdominal examination revealed a midline scar with an incisional hernia, and a transverse scar in the left iliac fossa at the site of the stoma closure. There was deep tenderness in the left hypochondrium, but no palpable masses or organomegaly. Rectal examination was normal.Routine blood investigation revealed microcytic, hypochromic anaemia (haemoglobin 10 g%), and a low albumen level (24 g/L). Carcinoembryonic antigen levels were normal. Computed tomography (CT) revealed a locally advanced jejunal lesion with proximal jejunal dilatation and enlarged mesenteric lymph nodes (Figure 1). The tumour was infiltrating the abdominal wall and the perinephric fat, and was closely adherent to the inferior pole of the spleen.Total parenteral nutrition was started and, following cardiac evaluation, the patient underwent exploratory laparotomy. This showed dense adhesions and a dilated proximal jejunum, alongside collapse of the distal jejunum and ileum. The tumour was mobilized and widely resected with an end-to-end small bowel stapled anastomosis (Figure 2).On the forth postoperative day, the patient complained of abdominal distension, and his blood press...

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Section: Discussionsupporting

confidence: 64%

“…Other presentations include weight loss, ileus and obscure gastrointestinal bleeding with chronic anaemia. 4 The diagnosis is often made on a small bowel series or CT. However, neither can differentiate a primary form a metastatic small bowel cancer.…”

Section: Discussionmentioning

confidence: 99%

Late metastatic colon cancer masquerading as primary jejunal carcinoma

Meshikhes

Joudeh

2016

annals

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“…The survival rates following resection of CRC metastasis to the small bowel are encouraging. Only 2 patients succumbed to disease progression at 1 and 26 months postoperatively (6,9,11). Furthermore, a case of disease-free survival of >11 years has also been reported (6).…”

Section: Discussionmentioning

confidence: 99%

“…Synchronous metastasis was observed in 2 cases, while the mean time of metachronous metastasis was 7 and 36 months after surgery. The main symptoms leading to evaluation, diagnosis and surgical resection were bowel obstruction and bleeding (6). Another study reported a series of 3 cases with metachronous metastatic small bowel cancer originating from CRC.…”

Section: Discussionmentioning

confidence: 99%

“…Only 2 patients succumbed to disease progression at 1 and 26 months postoperatively (6,9,11). Furthermore, a case of disease-free survival of >11 years has also been reported (6). Whether simple R0 resection via limited enterectomy is oncologically equivalent to radical resection (with concomitant removal of the segmental mesentery) remains to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

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Intraluminal rectal cancer metastasis to the small bowel: An extremely rare case report

Stamopoulos

Machairas

Kykalos

et al. 2017

Molecular and Clinical Oncology

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Abstract. Prolonged survival in patients suffering from colorectal cancer (CRC) may lead to the emergence of rare metastatic sites that are not well-documented in the literature. We herein describe a very rare case of an intraluminal small intestinal metastasis in a patient with previously resected CRC. A 71-year-old Caucasian male patient with a history of rectosigmoid junction cancer was initially treated with anterior resection. The tumor was classified as pT3pN0 (0/26) M0, stage II. Eighteen months after the primary surgery, local recurrence was detected in the presacral region, and the patient received combined image-guided radiotherapy and chemotherapy. Two months later, due to residual disease at the level of the anastomosis, the patient underwent additional low anterior resection with a diverting stoma. During extensive adhesiolysis, a small palpable intraluminal mass was identified in the jejunum, and segmental small bowel resection was performed. Pathological examination of the resected specimen confirmed that the lesion was a metastasis from the CRC primary. The precise mechanism and clinical significance of CRC metastasis to the small bowel remain unclear. There is limited clinical experience with this condition, as <20 cases have been reported in the literature to date. The main symptoms leading to evaluation, diagnosis and surgical resection are bowel obstruction and bleeding. The present case highlights the possibility of uncomplicated presence of metastatic CRC in the small bowel. Therefore, dilligent inspection of the peritoneal cavity, including the entire length of the gastrointestinal canal, is of paramount importance, particularly in cases of recurrent CRC. IntroductionColorectal cancer (CRC) constitutes a considerable cause of morbidity and mortality worldwide, representing the 3rd leading cause of cancer-related mortality in the USA (1). Approximately 135,000 new cases are diagnosed in USA annually, whereas ~50,000 CRC-related patient deaths are expected per year (1). Over half of the patients with CRC will develop metastases during their lifespan. The most common sites of CRC metastases include the liver, lung and peritoneum; however, various other metastatic sites, such as the bones, spleen, brain and distant lymph nodes, have also been described.Several improvements and strategic adjustments in the management of patients with metastatic CRC have subsequently led to remarkably improved outcomes (2). Changes in the clinical presentation of the patients, ameliorated preoperative assessment, tailored surgical resection, closer postoperative follow-up and advances in chemotherapeutic regimens represent some of these improvements, which have allowed for expansion of life expectancy in these patients (2). As a consequence, prolonged survival divulges rare metastatic sites that are not well-documented in the literature; the assessment and relevant results from the surgical management of these rare metastatic sites remain ill-reported. We herein describe a very rare case of small intestinal intr...

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Hematogenous intestinal metastases from sigmoid colon cancer presenting as iliopsoas abscess and bowel obstruction

et al. 2019

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Intestinal metastases from colorectal cancer typically occur by intraperitoneal spread, whereas those occurring via hematogenous route are exceedingly rare. We report a case of intestinal metastases from sigmoid colon cancer that presented as iliopsoas abscess and ileus. A 78-year-old man who had undergone sigmoidectomy for sigmoid colon cancer 5 years ago was referred to our hospital with recurrent ileus and fever. Abdominal computed tomography showed a left iliopsoas abscess and a mass near the abscess that had ostensibly caused ileus. The patient underwent segmental resection of the jejunum including the mass. Histopathological examination of the resected specimen revealed moderately differentiated adenocarcinoma proliferating mainly in the submucosal and muscular layers, which was pathologically identical to the colon cancer resected 5 years ago. He died 18 months after the surgery because of liver metastases. This case report highlights the delayed occurrence of colorectal metastases at unusual sites, such as the small bowel, more than 5 years after the resection of the primary cancer. Intestinal metastases should be considered in patients with a history of colon cancer, particularly in those with recurrent ileus or abdominal abscess with no obvious cause.

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Metastatic Small Bowel Tumor from Descending Colon Cancer with Extensive Hematogenous or Lymphogenous Spread: Survey of the Japanese Literature

Cited by 11 publications

References 3 publications

Late metastatic colon cancer masquerading as primary jejunal carcinoma

Late metastatic colon cancer masquerading as primary jejunal carcinoma

Intraluminal rectal cancer metastasis to the small bowel: An extremely rare case report

Hematogenous intestinal metastases from sigmoid colon cancer presenting as iliopsoas abscess and bowel obstruction

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