title: Occult solitary submucosal jejunal metastasis from esophageal carcinoma.
abstract: BACKGROUND
  Metastatic tumors of the intestinal tract from extra-abdominal sites are rare. In esophageal cancer, the liver, lung and the bones are the most common sites of metastases. Metastasis to intestines are very rare.
  
  
  METHODS
  A 54-year old male was admitted with esophageal squamous cell carcinoma (SCC) associated with dysphagia II-III and weight loss of 20 kg. Preoperative routine staging failed to detect any metastases. A transthoracic esophagectomy and orthotopic gastric pull-up with collar esophago-gastrostomy, associated with 2-field lymphadenectomy was performed. During the digital placement of the naso-jejunal feeding catheter a submucosal jejunal nodule with a diameter of 1 cm, about 40 cm distal to the duodeno-jejunal fold was detected which was completely resected by jejunotomy. Histopathology of jejunal nodule showed metastasis from esophageal squamous cell carcinoma.
  
  
  CONCLUSIONS
  Because of the extensive esophageal lymphatic system, an occult widespread dissemination of the tumor cells into the abdominal cavity is possible. Additional intraoperative evaluation of the small intestine and the complete abdominal cavity should be performed in every operation of esophageal carcinoma to detect possible occult intraabdominal metastases.
authors: Department of Thoracic and Hyperbaric Surgery, University Medical School, Auenbruggerplatz 29, Graz, Austria. jo.lindenmann@meduni-graz.at
authors: Joerg
authors: J
authors: Lindenmann
authors: Franz
authors: F
authors: Gollowitsch
authors: Veronika
authors: V
authors: Matzi
authors: Christian
authors: C
authors: Porubsky
authors: Alfred
authors: A
authors: Maier
authors: Freyja Maria
authors: FM
authors: Smolle-Juettner