内容紹介
A Case of Lung Cancer with Small Intestine Metastasis with Perforative Peritonitis as the Initial Symptom
Summary
Herein, we report a case of lung cancer with metastasis to the small intestine, with perforative peritonitis as the initial symptom. An 82-year-old man who had undergone subtotal gastrectomy and Roux-en-Y anastomosis for gastric cancer 8 years previously was admitted to our hospital with abdominal pain. We diagnosed the patient with gastrointestinal perforation, and a chest computed tomography(CT)scan showed a mass in the right lung. A laparotomy revealed a 4×3 cm sized intestinal tumor and intestinal perforation in the immediate vicinity of the anastomotic site. Segmentectomy of the small intestine was performed. Histological examination indicated that the tumor specimen was squamous cell carcinoma. Four months later, an abdominal CT scan showed multiple liver metastases, and the patient died 6 months after the operation because of cachexia. At autopsy, a diagnosis of small intestine metastatic tumor originating from squamous cell carcinoma of the lung was made. Although small intestine metastasis from lung cancer is rare, it should be considered when progressive abdominal symptoms are observed.
要旨
患者は82歳,男性。8年前に胃癌に対して胃全摘術(Roux-en-Y再建)を施行した。左下腹部痛を主訴に当院紹介となり,消化管穿孔による汎発性腹膜炎と診断し,緊急手術を施行した。胃全摘時の空腸空腸吻合部近傍に4×3 cm大の2型腫瘍が存在し,穿孔していた。病理検査で扁平上皮癌と診断した。入院時のCT検査で右肺下葉に腫瘤影を認めており,術後PET-CT検査では同部位にFDGの高集積を認めた。術後約6か月に死亡し,手術・剖検の結果から肺扁平上皮癌の小腸転移と診断した。急性腹症の患者では,肺および他臓器からの小腸転移も念頭に置いた全身検索が必要である。
目次
Summary
Herein, we report a case of lung cancer with metastasis to the small intestine, with perforative peritonitis as the initial symptom. An 82-year-old man who had undergone subtotal gastrectomy and Roux-en-Y anastomosis for gastric cancer 8 years previously was admitted to our hospital with abdominal pain. We diagnosed the patient with gastrointestinal perforation, and a chest computed tomography(CT)scan showed a mass in the right lung. A laparotomy revealed a 4×3 cm sized intestinal tumor and intestinal perforation in the immediate vicinity of the anastomotic site. Segmentectomy of the small intestine was performed. Histological examination indicated that the tumor specimen was squamous cell carcinoma. Four months later, an abdominal CT scan showed multiple liver metastases, and the patient died 6 months after the operation because of cachexia. At autopsy, a diagnosis of small intestine metastatic tumor originating from squamous cell carcinoma of the lung was made. Although small intestine metastasis from lung cancer is rare, it should be considered when progressive abdominal symptoms are observed.
要旨
患者は82歳,男性。8年前に胃癌に対して胃全摘術(Roux-en-Y再建)を施行した。左下腹部痛を主訴に当院紹介となり,消化管穿孔による汎発性腹膜炎と診断し,緊急手術を施行した。胃全摘時の空腸空腸吻合部近傍に4×3 cm大の2型腫瘍が存在し,穿孔していた。病理検査で扁平上皮癌と診断した。入院時のCT検査で右肺下葉に腫瘤影を認めており,術後PET-CT検査では同部位にFDGの高集積を認めた。術後約6か月に死亡し,手術・剖検の結果から肺扁平上皮癌の小腸転移と診断した。急性腹症の患者では,肺および他臓器からの小腸転移も念頭に置いた全身検索が必要である。