title: A case report of small bowel obstruction from previously undiagnosed lobular breast carcinoma: First in Australian literature.
abstract: BACKGROUND
  This case report is the first in the Australian literature of a patient, without prior diagnosis, presenting with a bowel obstruction secondary to lobular breast cancer. This highlights a relatively rare cause of bowel obstruction, but also the importance of breast self-examination as a compliment to the current BreastScreen Australia program.
  
  
  METHODS
  A 67-year-old female presented to the Emergency Department with a 48-h history of sharp, constant epigastric pain, vomiting and constipation. The patient proceeded to emergency laparotomy for presumed large bowel obstruction, which revealed a stricture in the distal terminal ileum causing a distal small bowel obstruction. A right hemicolectomy was performed. Histopathology revealed the terminal ileum stricture to be metastatic lobular breast carcinoma. Clinical examination of the patient's right breast revealed a lesion suggestive of the primary malignancy despite a normal ultrasound and mammogram in 2014. After failing to progress, a CT scan was performed which revealed progressive small and large bowel distension. A repeat laparotomy was performed revealing dilated large bowel without obstructing pathology and an intact anastomosis. A loop ileostomy was performed. Following a further febrile episode, the patient decided to withdraw care and the patient passed away three weeks into her admission from suspected intra-abdominal sepsis.
  
  
  CONCLUSIONS
  Breast cancer is becoming the third most common cancer amongst Australian women with a significant burden of disease and mortality.
  
  
  CONCLUSIONS
  Despite the rare presentation, this case reminds the medical community and general population of the importance of breast self-examination and the BreastScreen Australia program.
authors.affiliation: Department of General Surgery, Redcliffe Hospital, QLD, 4020, Australia; Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, University of Sydney, Westmead Hospital, Westmead, NSW, 2145, Australia. Electronic address: adamcristaudo@bigpond.com.
authors.forename: Adam Thomas
authors.initials: AT
authors.lastname: Cristaudo
authors.affiliation: Department of General Surgery, Redcliffe Hospital, QLD, 4020, Australia. Electronic address: katherinezhu@hotmail.com.
authors.forename: Katherine Jing
authors.initials: KJ
authors.lastname: Zhu
keywords: Breast neoplasms; Carcinoma; Case report; Colorectal neoplasms; Gastrointestinal neoplasms; Intestinal obstruction; Lobular