转移性肺癌引起的胃肠道穿孔(GITP)非常罕见。症状可以从轻度腹部不适到严重和危及生命的肠穿孔。在这种情况下,我们描述了一个不寻常的例子,涉及鳞状非小细胞肺癌(NSCLC),小肠微观转移导致肠穿孔。我们的病人,一名71岁的男性,有右肺IIIa期鳞状细胞癌病史和吸烟史,已完成放化疗,目前正在接受durvalumab治疗.他向急诊室提出腹痛的投诉,恶心,腹胀.他对系统的审查没有发现其他重大问题,他的生命体征稳定.然而,腹部检查发现触诊和看护时明显扩张并有压痛。实验室结果对于白细胞增多,中性粒细胞左移和肾功能轻度升高具有重要意义。腹部和骨盆的CT扫描显示广泛的气腹,提示肠穿孔.因此,病人接受了紧急剖腹探查术,在此期间,发现空肠中0.6cmx0.3cm的小肠穿孔,需要切除受影响的肠段。术中食管胃十二指肠镜检查(EGD)显示正常。切除的肠的组织病理学检查显示鳞状细胞癌簇伴有促纤维化反应,影响缺损部位的粘膜下层和肌肉层,手术边缘无肿瘤或炎症。这一发现表明转移性疾病起源于已知的肺鳞状细胞癌。手术后,该患者因大肠杆菌和克雷伯菌腹膜炎引起的脓毒性休克而进入ICU,需要插管和加压循环支持。最终,经治疗后出院。该病例强调了鳞状NSCLC中微转移引起的症状性肠穿孔的罕见性,并强调了严格评估和及时手术干预的必要性。然而,重要的是要认识到并发症的巨大风险和高死亡率,导致具有挑战性的预后。因此,有已知肺癌病史并有腹部症状的个体应接受全面评估,以通过早期干预预防危及生命的并发症.
Gastrointestinal tract perforation (GITP) due to metastatic lung cancer is an exceptionally rare occurrence. Symptoms can range from mild abdominal discomfort to severe and life-threatening bowel perforation. In this
case presentation, we describe an unusual instance involving squamous non-small cell lung cancer (NSCLC), where microscopic metastases in the small bowel led to bowel perforation. Our patient, a 71-year-old male with a history of stage IIIa squamous cell carcinoma in the right lung and smoking history, completed chemoradiation therapy and is currently undergoing treatment with
durvalumab. He presented to the ED with complaints of abdominal pain, nausea, and abdominal distention. His review of systems revealed no other significant issues, and his vital signs were stable. However, the abdominal examination revealed noticeable distention with tenderness upon palpation and guarding. Laboratory results were significant for leukocytosis with a left shift of neutrophils and mildly elevated kidney function. A CT scan of the abdomen and pelvis revealed widespread pneumoperitoneum, indicating a bowel perforation. Consequently, the patient underwent an urgent exploratory laparotomy, during which a small bowel perforation measuring 0.6 cm x 0.3 cm in the jejunum was identified, necessitating the resection of the affected bowel segment. Intraoperative esophagogastroduodenoscopy (EGD) showed normal findings. The histopathological examination of the resected bowel revealed clusters of squamous cell carcinoma with a desmoplastic reaction, affecting the submucosal and muscular layers at the site of the defect, with surgical margins free of tumor or inflammation. This finding indicated metastatic disease originating from the known lung squamous cell carcinoma. After the operation, the patient was admitted to the ICU due to septic shock caused by E. coli and Klebsiella peritonitis, requiring intubation and circulatory support with pressors. Ultimately, he was discharged following treatment. This
case underscores the rarity of symptomatic bowel perforation from micro-metastasis in squamous NSCLC and emphasizes the need for rigorous assessment and timely surgical intervention. However, it is important to recognize the significant risk of complications and a high mortality rate, leading to a challenging prognosis. As such, individuals with a known history of lung carcinoma who present with abdominal symptoms should undergo comprehensive evaluation to prevent life-threatening complications through early intervention.