Small bowel perforation caused by metastasis from head and neck carcinomas is rare. We report a case of oropharyngeal carcinoma with metastasis to the small bowel.
A 64-year-old woman who had received radiotherapy for oropharyngeal carcinoma presented to us complaining of abdominal pain. CT revealed free air in the abdomen, and emergency surgery was performed. During explorative laparotomy, many tumors were detected in the mesentery; one of them had caused a free perforation and another had caused stricture of the small bowel. The tumors were resected, and the postoperative diagnosis was metastatic squamous cell carcinoma (p16 positive). The patient could eventually resume oral intake and was discharged from the hospital. However, 27 days after the operation, she presented again with abdominal pain. CT showed free air, and there was evidence of panperitonitis. She died 4 hours later.
Small bowel metastasis accounts for less than 10% of malignant tumors of the small bowel, and metastases to the small bowel secondary to head and neck SCC are very rare. Furthermore, they are rarely symptomatic and carry a very poor prognosis. Bowel perforation by metastasis is thought to occur in the terminal stages of cancer.
