Small Bowel Perforation Secondary to Metastatic Non-small Cell Lung Cancer. A Rare Entity with a Dismal Prognosis

Abstract

Small bowel perforation due to metastatic non-small cell lung cancer is a very rare clinical entity. The possibility of small bowel metastases should be kept in mind in patients with lung cancer presenting with an acute abdomen. Intestinal perforation occurs in advanced stages and is usually a sign of widespread disease. Aggressive surgery can provide effective palliation and may improve short-term survival. The prognosis is however dismal.

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

“…Meticulous exploration and irrigation of the peritoneal cavity should also be performed on an emergency basis and is the only way to revert ongoing sepsis. Despite the poor prognosis of these patients, surgery may provide acceptable palliation and lead to satisfactory survival (19,20). Indeed, Nagashima et al (21) reviewed 48 cases operated on for intestinal perforation due to metastatic lung cancer, and reported a median postoperative survival time of 48 days.…”

Bowel perforation secondary to metastatic lung cancer: Report of two cases with literature review

“…Findings of the imaging were useful to decide for emergency laparotomy but not for the diagnosis of abdominal metastasis. This diagnosis, however, is not easy and requires a high index of suspicion; conventional CT has a low sensitivity for small bowel metastasis (33%) while with intravenous and oral contrast reaches 87% [ 3 , 9 ]. The frequency of these metastases is more than expected [ 10 ] particularly in patients with longer survival [ 7 , 1 , [10] , [11] , [12] , [13] , [14] ].…”

“…Intussusception with consequent occlusion [ 15 , 26 , 27 ] has also been described. Bowel perforation means an advanced disease and a severe prognosis [ 10 , 6 ], which is characteristic of these patients [ 8 ]; perforations occur more often in jejunum (53%) than ileum (28%), less frequently in the duodenum [ [2] , [3] , [4] , [5] , [6] , [7] ]. Adenocarcinoma is the most common metastatic tumor follow by large cell neplasm in Table 1 we reported the results of some significant paper in the Literature.…”

“…Lung cancer is mostly diagnosed at the advanced stage of disease and gastrointestinal metastases from pulmonary neoplasm are rare [ 1 , 2 ] often with few or no symptoms; the incidence is estimated around 2–14% [ 3 ] and the first reported case dates back to the 60 s [ [4] , [5] , [6] ]. Histologically, poor tumor differentiation and advanced T and N stages are associated with intestinal metastasis; clinically, these led to three frequent clinical presentations, perforation, obstruction and bleeding.…”

Metastatic intestinal obstruction secondary to a primary lung tumour

“…1 Metastatic involvement of the small intestine is rare from a clinical point of view, but not so much from a histopathology perspective, with an incidence of 2%---14% according to autopsy series. 2 The clinical manifestation of intestinal metastases is generally due to a complication of the disease, such as perforation, obstruction or active bleeding. 3 Presence of any of these is associated with poorer prognosis of the underlying disease, and requires urgent surgical treatment.…”