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A case describes a 49-year-old male patient who underwent emergency exploratory laparotomy for small intestinal perforation. Peritonitis was present due to perforation of the jejunal tumor. Resection of the jejunal tumor with perforation was performed followed by end-to-end anastomosis of the jejunum. The resected jejunal tumor was identified in the histopathological examination as metastatic from a clear cell variant of squamous cell/large cell carcinoma of the lung. It was associated with metastatic lesions in the brain. Metastasis from the lung carcinoma in the jejunum is a very rare condition predisposing to small intestinal perforation which is also associated with brain metastasis., (© Journal of the Association of Physicians of India 2024.)

We here describe a case of an acute peritonitis due to perforation of a small intestine tumor metastasized from a lung cancer. A 66-year-old man who had undergone a bladder cancer procedure 2 years ago and was hospitalized for the second operation, complained sudden abdominal pain. An enhanced abdominal CTrevealed a small amount of free gas and ascites in the abdominal cavity. On the same day, emergency exploratory surgery was performed with the diagnosis of perforative peritonitis. A laparotomy revealed a jejunal tumor with perforation 40 cm distal from the Treitz ligament. After surgery, the patient confessed that he had got a notice of the recurrence of lung cancer which had been treated 9 years ago. The pathological result indicated the lesion was metastasis from lung cancer. Although small intestinal metastatic tumor from lung cancer is rare, it should be considered when acute abdomen is observed.

Background: The first reported case of intestinal perforation secondary to metastatic lung carcinoma was reported in 1957. Intestinal metastases are present in up to 1.8% of the cases, with small bowel obstruction as the most common clinical presentation., Clinical Case: An 89 year-old male, who was diagnosed with a high-grade pulmonary mucoepidermoid tumour 2 months previously. The patient was admitted to the hospital for 3 days due to diffuse colic abdominal pain of moderate to severe intensity, accompanied by nausea and gastric vomiting, as well as 2 episodes of bloody bowel movements. On physical examination, the patient was noted to have tachycardia and tachypnoea, as well as clinical signs of acute abdomen. He had white cells of 24,900 per mm 3 , and 87% neutrophils. Exploratory laparotomy was performed, which showed a bowel perforation associated with a tumour mass 15cm beyond the angle of Treitz. Bowel resection and primary anastomosis were performed. The histopathological analysis reported the diagnosis of a high-grade mucoepidermoid tumour with small bowel and mesentery with disease-free surgical margins. Unfortunately the patient had a fatal outcome secondary to hospital-acquired pneumonia., Conclusion: The cases of metastases to small bowel are extremely rare, and to our knowledge this is first case reported in Mexico. The patient described went to the emergency room with gastrointestinal bleed and intestinal perforation that required urgent surgical intervention with small bowel resection and primary anastomosis. Unfortunately the patient died secondary to hospital acquired pneumonia., (Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.)

Metastatic pleural mesothelioma is a rare disease. The present study aimed to report a rare presentation of metastatic malignant mesothelioma (MM). The patient was an elderly man who presented with small bowel (jejunal) perforation secondary to metastatic pleural mesothelioma deposits. This was a rare presentation of a rare disease and the first reported case in the published studies in which MM masqueraded as bowel perforation prior to the primary diagnosis., Similar Cases Published: 1.

Herein, we report a case oflung cancer with metastasis to the small intestine, with perforative peritonitis as the initial symptom. An 82-year-old man who had undergone subtotal gastrectomy and Roux-en-Y anastomosis for gastric cancer 8 years previously was admitted to our hospital with abdominal pain. We diagnosed the patient with gastrointestinal perforation, and a chest computed tomography(CT)scan showed a mass in the right lung. A laparotomy revealed a 4×3 cm sized intestinal tumor and intestinal perforation in the immediate vicinity ofthe anastomotic site. Segmentectomy ofthe small intestine was performed. Histological examination indicated that the tumor specimen was squamous cell carcinoma. Four months later, an abdominal CT scan showed multiple liver metastases, and the patient died 6 months after the operation because ofcachexia. At autopsy, a diagnosis ofsmall intestine metastatic tumor originating from squamous cell carcinoma of the lung was made. Although small intestine metastasis from lung cancer is rare, it should be considered when progressive abdominal symptoms are observed.

A 63-year-old male patient was referred to our department for an abnormal shadow in the left middle lung field. The patient underwent trans bronchial lung biopsy and pathological finding was adenocarcinoma. Computed tomography( CT) showed mass in the left lower lobe, nodules in the bilateral adrenal glands, liver, pancreas and lumbar bone. When he was admitted to our hospital for chemotherapy, chest X-ray showed left pneumothorax and a chest tube was placed. Several days later, he complained of sudden abdominal pain and abdominal CT revealed free air around small intestine. Emergency operation was done and the perforation of the small intestine due to metastasis was found. He underwent partial resection of small intestine and left lower lobectomy. Pathological diagnosis was pulmonary pleomorphic carcinoma and small intestine metastasis.

Introduction: Lung cancer metastases of small bowel are rare (1,1%), often with few or not symptoms. This aspecific onset and the difficult physical-instrumental approach to small bowel, led often to diagnosis at autopsy. This is not true for intestinal metastases that cause complications (haemorrhage, obstruction, perforation); in this cases emergency surgery leds to the diagnosis., Case Report: We describe a case of a male 56 years old patient with acute abdomen due to perforation (X-ray and CT). He refers, about 6 months before, an upper right lobectomy for lung cancer, followed by adjuvant chemo-radiotherapy, because the presence of brain and bone metastases. During the emergency surgery we found out a perforation of the Treitz tract, treated with intestinal resection and immediate end-to-end anastomosis with manual suture. Histological examination shows the perforation of the intestinal wall tract with lung cancer metastases., Conclusions: Our case shows that any acute abdomen in patient with lung cancer can be considered as expression of intestinal metastases. Negative prognosis of this complication imposes to surgeons only a local treatment.

The Authors present the third case of small-bowel perforation of a metastatic sarcomatoid carcinoma of the lung. A 62-year-old man underwent a right upper lobectomy because of a lung tumour infiltrating the posterior thoracic wall. The histology showed pleomorphic subtype of a sarcomatoid carcinoma (pT3 pN0 cM0). The postoperative course was uneventful and thus the patient received 5 000 cGY over five weeks. After 5 months the patient was admitted to the Surgical Department for acute abdomen. At laparotomy an advanced fibrinous, bile-stained peritonitis secondary to a solitary perforation of the jejunum 50 cm distal to the Treitz were observed. The microscopical examination showed that the perforated mass consisted of infiltration of dischoesive malignant giant cells, highly pleomorphic multi and mononucleated. The immunohistochemistry, performed with multiple keratin antibodies, revealed epithelial differentiation of malignant cells, compatible with a metastatic carcinoma, consistent to the lung primary. In conclusion, according with literature, the small-bowel perforation is a rare presentation of a metastatic lung carcinoma, and particularly of a sarcomatoid carcinoma. It should be considered in differential diagnosis of patients with acute abdominal symptoms especially in those with a previous treated lung cancer. The surgeons should be aware of the poor outcome of these patients and choose a palliative treatment.

Choriocarcinoma is a rare malignant genital tract tumor, arising in the uterus or in the testis. Primary or metastatic choriocarcinomas of the gastrointestinal tract are infrequent. We report a case of a testis choriocarcinoma presenting as jejunal metastasis with perforation. Histology revealed the origin of this metastatic tumor, allowing us to recognize the primary neoplasm of the testis. A review of literature with PubMed since 1964 and of the references of the papers retrieved was performed. Since 1933 only 30 cases of jejunal choriocarcinomas have been described in literature. In 13 cases jejunal choriocarcinoma presented gastrointestinal hemorrhage, in 4 intestinal intussusception and in 1 case upper abdominal pain and vomiting. Only 5 cases of jejunal perforation have been described. The case presented is the first in literature of jejunal perforation from a metastatic choriocarcinoma of the testis.

The authors report a rare case of acute onset of non-Hodgkin lymphoma with diffuse peritonitis due to bowel perforation of secondary jejunal involvement. The admission diagnosis in the 18-years-old male with acute abdominal pain for 4 days, guarding on physical examination and pneumoperitoneum on abdominal ultrasonography was peptic ulcus perforation. The palpable splenomegaly and cervical lymph nodes on ultrasonography examination might have raised suspicion of lymphoma. Surgical exploration revealed the peritonitis origin--jejunal perforation, proximal to a stenosing tumor, a gastric tumor and confirmed the splenomegaly. Small bowel resection--end to end anastomosis--and gastric tumor biopsies were performed. The pathological diagnosis was diffuse large B-cell non-Hodgkin lymphoma. Some therapeutic considerations on digestive tract secondary lymphoma are made.

Small bowel perforation is rarely caused by metastasis from an extra-abdominal malignancy. This report describes three cases of small bowel perforation that occurred secondary to a metastatic tumor. The first case involved a 72-year-old man with malignant lymphoma of the larynx that had been treated with chemo- and radiation therapy; the second involved a 70-year-old man with rhabdomyosarcoma of the mediastinum that had been treated with radiation therapy; and the third involved a 41-year-old man with lung carcinoma that had been treated with surgery 10 months prior to perforation. Each patient presented with acute abdominal pain, had X-ray findings of free air in the abdomen, and underwent limited emergency surgery. Wedge resection and closure of the ileum was performed for the first patient and partial bowel resection with the creation of an intestinal stoma was performed for the second and third patients. In each case, the histologic findings of the resected specimens were consistent with the extra-abdominal primary tumors. Although the patients recovered sufficiently to begin eating and moving about, all three died of cancer or cancer-related complications within 45 days of surgery. We conclude that surgeons should be aware of the poor prognosis of such patients and perform only the minimal surgery required.

Emergency surgery for bowel perforation caused by metastases from lung cancer is rare. Two cases of small bowel perforation due to metastasizing lung cancer are reported. Both patients were admitted as a surgical emergency case. One of the two patients presented herein survived and was discharged from the hospital. Perforated small bowel due to metastatic lung cancer is a highly fatal event that occurs in the late phases of the disease. Despite the poor prognosis, early and appropriate therapy will occasionally yield successful surgical palliation. Patients with known lung cancer who develop abdominal complaints should be examined thoroughly and treated quickly.

Perforation from a solitary metastatic lesion of the small bowel is rare. We report a case of acute perforation with no evidence of metastatic disease within the abdomen. Resection of the small bowel was performed.

A case of acute abdominal pain due to jejunal perforation in a patient with dissemination of laryngeal carcinoma is presented. Six jejunal intramural nodes of squamous cell carcinoma, one of them perforated, were observed at laparotomy. At the same time, a lesion suspicious of local recurrence in the tracheostomy orifice was observed. The patient died in the postoperative period. The rarity of intestinal perforation as an initial manifestation of metastatical dissemination of a laryngeal squamous cell carcinoma as well as its poor prognosis are discussed. The hematogenous spread is proposed in our case. Finally the inclusion of metastases in the differential diagnosis in a clinical episode of intestinal perforation in patients with a history of neoplasm is emphasized.

The Authors report a case of peritonitis due to perforation of a single small bowel metastasis in a woman affected by right upper lobar lung carcinoma still with neck's lymphnodes and cerebellar metastasis. They underline the rarity of the finding and analyze its clinical, therapeutic, prognostic problems.

Although intestinal metastases from lung cancer are not rare at postmortem studies, the development of clinically significant symptoms from the gastrointestinal metastases is very unusual. We report a case of small intestinal hemorrhage leading to intestinal perforation secondary to metastases from a large cell carcinoma of the lung in a 31-year-old man along with a review of the literature.

On first admission on June 5, 1989, pulmonary adenocarcinoma of left S3b in a 62-year-old male had already metastasized to the brain and the clinical stage was T2N2M1. Radiation therapy for the metastatic brain lesion was very successful but chemotherapy for the primary lesion was not effective. He was discharged on August 24, 1989. He was readmitted to our hospital on Jan. 5, 1990 because of severe abdominal pain. His chest roentgenogram showed free air under the diaphragm. An emergency laparotomy was performed, because perforation of gastrointestinal tract was suspected. At operation, two localized tumors were found, one located in the jejunum approximately 20 cm distal to the ligament of Treitz, accompanied by perforation and another approximately 20 cm distal to the above lesion in the mesentery. The resected specimen of the perforated lesion demonstrated a deep and large ulcer, compared to the tumor size, similar to a submucosal tumor, accompanied by bridging folds. The pathologic interpretation was adenocarcinoma of the lung metastatic to the jejunum and mesentery. Primary lung cancer metastasizes to a wide variety of organs, but metastasis to the small intestine is uncommon, even on postmortem examination. Furthermore, it is rare that the metastatic lesion causes abdominal symptom leading to laparotomy.

A 76-year-old man with lung carcinoma, who was undergoing both radiotherapy and chemotherapy (CDDP + ADR) suddenly died with the onset of abdominal symptoms. Autopsy disclosed that the main cause of death was suppurative panperitonitis, caused by a perforation of a metastatic lesion at the jejunum. A histological examination revealed extensive tumor necrosis in the metastatic liver lesions as well as in the jejunal lesions. Neither inflammatory nor circulatory damage was observed in the perforated lesion. Therefore, the cause of this perforation was considered to be chemotherapy that had brought on tumor necrosis. No similar reports of lung cancer deaths have been found in the literature in which the microscopic details were described. Accordingly, this case is reported for future reference with regard to cancer chemotherapy.

A case of squamous cell carcinoma of lung presenting with acute abdominal pain secondary to jejunal perforation at the site of a solitary metastatic lesion is presented. The literature regarding this unusual presentation of lung cancer is reviewed.

A case of peritonitis secondary to the perforation of a bronchogenic small bowel metastasis is reported. To our knowledge this is only the fourth case in which peritonitis was the presenting feature of a squamous cell carcinoma of the bronchus. The publications to date are reviewed and the need to biopsy every small bowel perforation found at laparotomy is stressed.

After curative pneumonectomy for bronchogenic carcinoma, the first sign of generalization was a peritonitis secondary to the perforation of a jejunal metastasis. The authors review the frequency and etiology of this type of intestinal metastasis as well as the mechanism of perforation.

Since 1961, there have been a total of seven patients with small bowel perforation caused by metastatic lung carcinoma reported in the literature. Perforation of the small bowel to metastatic lung carcinoma must be considered when evaluating older patients who have histories of heavy cigarette smoking and signs and symptoms suggestive of pulmonary neoplasia. Primary resection and end-to-end anastomosis of the perforated bowel is the treatment of choice. No patient with small bowel perforation secondary to lung carcinoma has survived more than four months.