[Jejunal perforation secondary to pulmonary mucoepidermoid carcinoma metastasis. Case report and review].
BACKGROUND
The first reported case of intestinal perforation secondary to metastatic lung carcinoma was reported in 1957. Intestinal metastases are present in up to 1.8% of the cases, with small bowel obstruction as the most common clinical presentation.


METHODS
An 89 year-old male, who was diagnosed with a high-grade pulmonary mucoepidermoid tumour 2 months previously. The patient was admitted to the hospital for 3 days due to diffuse colic abdominal pain of moderate to severe intensity, accompanied by nausea and gastric vomiting, as well as 2 episodes of bloody bowel movements. On physical examination, the patient was noted to have tachycardia and tachypnoea, as well as clinical signs of acute abdomen. He had white cells of 24,900 per mm3, and 87% neutrophils. Exploratory laparotomy was performed, which showed a bowel perforation associated with a tumour mass 15cm beyond the angle of Treitz. Bowel resection and primary anastomosis were performed. The histopathological analysis reported the diagnosis of a high-grade mucoepidermoid tumour with small bowel and mesentery with disease-free surgical margins. Unfortunately the patient had a fatal outcome secondary to hospital-acquired pneumonia.


CONCLUSIONS
The cases of metastases to small bowel are extremely rare, and to our knowledge this is first case reported in Mexico. The patient described went to the emergency room with gastrointestinal bleed and intestinal perforation that required urgent surgical intervention with small bowel resection and primary anastomosis. Unfortunately the patient died secondary to hospital acquired pneumonia.
Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México. Electronic address: laloxys@hotmail.com.
Eduardo
E
Moreno-Aguilera
Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Francisco Iván
FI
Galeana-Nogueda
Texas Tech University Health Sciences Center, Internal Medicine, Lubbock, Texas, Estados Unidos de América.
Jesús
J
Vera-Aguilera
Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México.
Carlos
C
Vera-Aguilera
Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Luis Alfonso
LA
Ley-Marcial
D000006:Abdomen, Acute / Q000209:etiology; D000369:Aged, 80 and over; D018277:Carcinoma, Mucoepidermoid / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary*; D003428:Cross Infection / Q000209:etiology; D017809:Fatal Outcome; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology*; D007579:Jejunal Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D007580:Jejunal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary*; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D014057:Tomography, X-Ray Computed
Carcinoma pulmonar de células no pequeñas; Jejunal perforation; Manejo quirúrgico; Metátasis a intestino delgado; Non-small-cell lung carcinoma; Perforación yeyunal; Small bowel metastasis; Surgical management