A Case of Intussusception and Bleeding Due to Small-intestinal and Duodenal Metastases from a Rapidly Growing Pulmonary Pleomorphic Carcinoma

Abstract

The patient was a 70-year-old male in whom a chest x-ray and CT performed during a routine medical checkup revealed a mass in the upper lobe of the right lung. He visited our emergency department with a history of having noticed black stools five days previously and experiencing periumbilical pain from the day before. Abdominal CT revealed evidence of intestinal obstruction. The patient was hospitalized, but he failed to improve with conservative treatment. Therefore, we performed laparoscopic-assisted surgery on hospital day 13. In addition to the tumor that was believed to be the main cause of the intestinal obstruction, multiple tumors were found throughout the small intestine. One of these tumors caused invagination, and we performed partial resection of the main lesion and the tumor causing the intussusception. After surgery, the anemia caused by bleeding from the remaining intestinal tumors and newly found tumors in the duodenum progressed rapidly and the patient died on hospital day 26. The resected tumors were histopathologically diagnosed as metastatic lesions from a pulmonary pleomorphic carcinoma. Small bowel metastases from a pulmonary pleomorphic carcinoma are relatively rare and carry an extremely poor prognosis. In some cases, such as our case reported herein, the cancer progresses rapidly and we believe it is important not to miss the appropriate time for initiation of chemotherapy.