Small bowel metastases from primary carcinoma of the lung: Clinical findings and outcome

OBJECTIVE: Symptomatic small bowel metastases from primary carcinoma of the lung have been rarely reported. The aim of this study was to describe clin ical presentation and outcome in a series of patients. METHODS: Between 1984 and 1996, 1544 patients with lung cancer were referre d to our institution for surgery and 1399 were operated on. Seven of them. developed a symptomatic small bowel metastasis, Clinical, radiological, and pathology records were reviewed. RESULTS: In 6 of 7 patients, the lung cancer was previously operated on fro m 0.5 to 24 months before the diagnosis of small bowel metastasis. In 1 pat ient, the primary tumor was diagnosed after small bowel metastasis resectio n. Clinical symptoms at presentation were acute peritonitis in 2 patients, progressive digestive obstruction in 3, and gastrointestinal bleeding in 2. The diagnosis was suspected on abdominal ultrasonography in 2 cases, and s mall bowel radiography in 3 cases. It was confirmed either by computed tomo graphic scan or by push enteroscopy. All patients underwent operation (inte stinal resection in 6 and bypass in 1) with no postoperative death. Small b owel metastases were located in the jejunum in 2 patients, in the ileum in 3, and in both sites in 2. Histological features of the metastases were ide ntical to the primary tumor: squamous cell carcinoma (n = 3), undifferentia ted large cell carcinoma (n = 2), adenosquamous carcinoma (n = 1), and aden ocarcinoma (n = 1). In 6 patients, small bowel metastases were associated w ith other metastatic sites. Six patients died within 8 months after metasta sis resection. One patient was alive 22 months after bowel resection. CONCLUSIONS: Symptomatic small bowel metastases can occur early in the cour se of lung cancer. Resection should be considered as the best palliative tr eatment to prevent bowel obstruction or peritonitis. (Am J Gastroenterol 19 99;94: 1884-1887. (C) 1999 by Am. Cell. of Gastroenterology).