Small bowel obstruction due to metastatic pulmonary adenocarcinoma
Presentation
Three week history of nausea and bloating after eating and drinking. Previous laparoscopic cholecystectomy, umbilical hernia repair, and colonoscopy showing a narrowed sigmoid with 3 benign polyps.
Patient Data
There is a distal small bowel obstruction with transition point in the ileum, in addition to colitis affecting the distal descending, sigmoid colon, and rectum. This combination of findings raises the possibility of inflammatory bowel disease.
Retroperitoneal lymphadenopathy also noted.
Case Discussion
Because of the distribution of disease this patient's small bowel obstruction was assumed to secondary to Crohn disease. However the patient failed conservative management and proceed to having a laparotomy.
At the time of laparotomy there was two segments of suspicious small bowel that was resected and the sigmoid colon was also resected.
Histology of the small bowel showed metastatic adenocarcinoma likely pulmonary origin.
Histology of the sigmoid colon showed active diverticulitis with no evidence of malignancy.
Staging scans showed the primary surrounding the right main bronchus.
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