title: Small Intestinal Metastasis from Esophageal Squamous Cell Carcinoma Presenting with Perforated Peritonitis.
abstract: Metastatic tumors of the small intestinal tract from extra-abdominal sites are rare. We report herein a rare case of small intestinal metastasis from esophageal carcinoma that presented with perforated peritonitis. A 71-year-old man with dysphagia was referred to our hospital for further examination and treatment, and was diagnosed with type 3 advanced esophageal squamous cell carcinoma of the lower thoracic esophagus. Based on a diagnosis of Stage II cancer, a radical esophagectomy with three-field lymph node dissection was performed after neoadjuvant chemotherapy composed of 5-fluorouracil plus cisplatin. Pathological examination of the resected specimen revealed a moderately differentiated squamous cell carcinoma, extending into the adventitia with lymph node metastasis (T3, N2, M0, Stage III). During postoperative adjuvant chemotherapy, the patient complained of abdominal pain and was found to have perforated peritonitis. Emergency laparotomy was performed. A jejunal perforation with a submucosal nodule approximately 80 cm distal from the ligament of Treitz was detected, and completely resected by jejunal partial resection. Histopathology of the specimen showed a perforation of the small intestine due to metastasis of esophageal squamous cell carcinoma with mesenteric lymph node metastasis. The patient died of cancer 9 months after surgery. An extremely rare case of small intestinal metastasis from esophageal carcinoma presenting with perforated peritonitis was described.
authors.affiliation: Department of Surgery, Tokai University School of Medicine, Tokyo Hospital, 1-2-5 Yoyogi, Shibuya-ku, Tokyo 151-0053, Japan. o-chino@is.icc.u-tokai.ac.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Chino
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Makuuchi
authors.forename: Soji
authors.initials: S
authors.lastname: Ozawa
authors.forename: Hideo
authors.initials: H
authors.lastname: Shimada
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nishi
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Hirohito
authors.initials: H
authors.lastname: Miyako
authors.forename: Eisuke
authors.initials: E
authors.lastname: Ito
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kise
authors.forename: Tadashi
authors.initials: T
authors.lastname: Hara
authors.forename: Akihito
authors.initials: A
authors.lastname: Kazuno
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kajiwara
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary*; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D017809:Fatal Outcome; D006801:Humans; D007414:Intestinal Neoplasms / Q000473:pathology / Q000556:secondary*; D007416:Intestinal Perforation / Q000209:etiology* / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008643:Mesentery; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010538:Peritonitis / Q000209:etiology* / Q000473:pathology