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

Abstract

The present report describes the case of an 81-year-old woman who underwent an emergency explorative laparotomy due to small bowel perforation. Diffuse feculent peritonitis due to perforation of the jejunum was identified. In addition, six distinct tumors of the jejunum in close proximity to the perforation site, as well as two more lesions caudally at the ileum, were identified. A separate stenotic tumor was identified at the sigmoid colon, causing moderate dilatation of the whole intestine. An enterectomy, including the perforation site and the proximal six tumors, was performed, followed by limited enterectomies for the distal two tumors and side-to-side anastomoses of the small intestine. All resected tumors were identified at histology as metastatic from lung carcinoma. Postoperatively, the patient remained in a severe septic condition and succumbed the following day. Metastatic lesions from lung carcinoma in the small bowel wall are a rare finding predisposing to bowel perforation. When an acute condition coexists with multiple intestinal metastases, the mortality rate is high despite prompt surgical intervention. More specifically, such metastatic lesions are more commonly encountered in the advanced stages of the disease and are consequently associated with unfavorable disease prognosis. With regards to associated symptomatology, when the metastatic disease involves the upper gastrointestinal tract, bleeding is the most common symptom, whilst when the small intestine is involved, the most typical manifestation is intestinal obstruction, with or without perforation (4). Herein, a rare case of a surgical patient with acute abdomen due to small bowel perforation and multiple intestinal metastases from lung carcinoma is reported.