Salemis Nikolaos S, Nikou Efstathios, Liatsos Christos, Gakis Christos, Karagkiouzis Grigorios, Gourgiotis Stavros
Second Department of Surgery, Army General Hospital, 19 Taxiarhon Str, 19014, Kapandriti, Athens, Greece.
J Gastrointest Cancer. 2012 Sep;43(3):391-5. doi: 10.1007/s12029-011-9329-2.
The incidence of gastrointestinal metastases from lung cancer is higher than previously thought as they have been reported in 2-14% of the cases in autopsy studies. However, clinically significant metastases are rare. Small bowel perforation secondary to metastatic non-small cell lung cancer is a very rare clinical entity. The aim of this study is to describe a case of ileal perforation in a patient with intestinal metastases of a non-small cell lung cancer, along with a review of the literature.
A 57-year-old male with a history of non-small cell lung cancer was referred to our emergency department with signs and symptoms of acute surgical abdomen. A computed tomography scan demonstrated dilated small bowel loops, liver deposits, and signs of perforation of an intra-abdominal hollow viscus.
Emergency exploratory laparotomy revealed diffuse purulent peritonitis and a perforated ileal tumor. A segmental small bowel resection and primary anastomosis were performed. Histological and immunohistochemical findings were consistent with a metastatic non-small cell lung carcinoma. Additional evaluation revealed widespread metastatic disease. Unfortunately, despite adjuvant treatment, the patient died of progressive disease 2 months after surgery.
Small bowel perforation due to metastatic non-small cell lung cancer is a very rare clinical entity. The possibility of small bowel metastases should be kept in mind in patients with lung cancer presenting with an acute abdomen. Intestinal perforation occurs in advanced stages and is usually a sign of widespread disease. Aggressive surgery can provide effective palliation and may improve short-term survival. The prognosis is however dismal.
肺癌胃肠道转移的发生率高于以往认为的情况，尸检研究报告其发生率为2% - 14%。然而，具有临床意义的转移很少见。转移性非小细胞肺癌继发小肠穿孔是一种非常罕见的临床情况。本研究的目的是描述一例非小细胞肺癌肠道转移患者发生回肠穿孔的病例，并对相关文献进行综述。
一名有非小细胞肺癌病史的57岁男性因急性外科急腹症的症状和体征被转诊至我院急诊科。计算机断层扫描显示小肠肠袢扩张、肝脏有沉积物以及腹腔内中空脏器穿孔的迹象。
急诊剖腹探查发现弥漫性化脓性腹膜炎和回肠肿瘤穿孔。进行了小肠节段性切除和一期吻合术。组织学和免疫组化结果与转移性非小细胞肺癌一致。进一步评估显示存在广泛的转移性疾病。不幸的是，尽管进行了辅助治疗，患者在术后2个月死于疾病进展。
转移性非小细胞肺癌导致的小肠穿孔是一种非常罕见的临床情况。对于出现急腹症的肺癌患者，应考虑小肠转移的可能性。肠穿孔发生在晚期，通常是广泛疾病的征象。积极的手术可以提供有效的姑息治疗，并可能改善短期生存。然而，预后很差。
