Colonic metastases from small cell carcinoma of the lung presenting with an acute abdomen

The acute abdomen is a usual surgical emergency seen in national and international emergency departments, and it has several causes. A correct clinical history and the knowledge of diseases that cause acute abdomen are crucial for a correct diagnosis, and for a quick and efficient treatment.

The authors present a case of a male patient with small cell carcinoma of the lung, who resorted to the emergency department because of abdominal pain. Acute abdomen due to acute appendicitis was the diagnosis. During laparotomy two colonic tumoral lesions were identified, and a normal appendix was found. Pathology concluded for colonic metastases from small cell carcinoma of the lung.

Although several similar case reports are found in the literature, it is always good to remember these less frequent causes of acute abdomen, which may pass unnoticed if we do not know their existence. Only a low threshold of suspicion will allow a fast and correct diagnosis and treatment.

Authors and Affiliations:

Nome: Carlos Eduardo Costa Almeida

Afiliação: Centro Hospitalar e Universitário de Coimbra, Hospital Geral (Covões), Serviço de Cirurgia C

Nome: Luis S Reis

Afiliação: Centro Hospitalar e Universitário de Coimbra, Hospital Geral (Covões), Serviço de Cirurgia C

Nome: Carlos M Costa Almeida

Afiliação: Centro Hospitalar e Universitário de Coimbra, Hospital Geral (Covões), Serviço de Cirurgia C

Abstract:

INTRODUCTION: Colonic metastases are rare, and usually secondary from malignant tumours of the stomach, breast, ovarian, cervix, kidney, lung, prostate, or skin. Around one third are asymptomatic or found only at autopsy.

CASE REPORT: A middle-aged male smoker, who had a small cell carcinoma of the lung diagnosed two years previously and treated with radiotherapy and chemotherapy, was admitted to the emergency room with intense abdominal pain and constipation. With the suspicion of an acute appendicitis he was submitted to surgery. At laparotomy he was found to have a normal appendix but two hard colonic lesions: a mobile one in the right colon and the other fixing the sigmoid colon to the sacrum. A right hemicolectomy and a sigmoid loop colostomy were performed. Pathology showed those lesions to be colonic metastases from small cell carcinoma of the lung.

DISCUSSION: Colonic secondaries are most frequently diagnosed in patients who have had a known primary tumour, and may present with bowel obstruction, lower gastrointestinal haemorrhage, gastrointestinal fistula, or intestinal perforation. Presentation with acute abdomen is rare, and survival is usually limited.

CONCLUSION: Colonic metastatic disease should be considered in any patient presenting with an acute abdomen and past history of lung malignancy.

Journal: International Journal of Surgery Case Reports

Link: http://www.sciencedirect.com/science/article/pii/S2210261215000991