Small bowel perforation secondary to metastatic lung carcinoma.

Since 1961, there have been a total of seven patients with small bowel perforation caused by metastatic lung carcinoma reported in the literature. Perforation of the small bowel to metastatic lung carcinoma must be considered when evaluating older patients who have histories of heavy cigarette smoking and signs and symptoms suggestive of pulmonary neoplasia. Primary resection and end-to-end anastomosis of the perforated bowel is the treatment of choice. No patient with small bowel perforation secondary to lung carcinoma has survived more than four months.     

A case of perforation of the metastatic site of lung carcinoma in the small bowel

Metastasis of lung carcinoma in the small bowel is so extremely rare as there were 53 cases in total with small bowel metastasis from lung carcinoma reported in the past literature. A case of a 72-year-old man with unresectable lung carcinoma (squamous cell carcinoma) was reported, he had an acute perforation of the small bowel following intensive course of irradiation therapy for primary site. Emergency operation was performed, but he died of DIC (disseminated intravascular coagulation) 3 days after surgery.     

A rare case of metastatic lung cancer to the bladder

Cancer metastasis to the bladder from non-contiguous sites is very rare. Lung metastasis to the bladder is even more uncommon, with an extensive literature search identifying only four documented cases in the past 20 years. Of these four cases, only one was from lung adenocarcinoma. In this report, we present the case of a 66-year-old male with known lung adenocarcinoma found to have the incidental finding of a bladder mass upon computed tomography imaging. Histochemical staining of samples from the bladder confirmed metastatic dissemination from the primary lung malignancy.     

Small bowel perforation secondary to accidental dental plate ingestion

The majority of ingested foreign bodies will pass through the gastrointestinal tract without incident, with less than 1% of cases resulting in complications. Herein we present a case of small bowel perforation secondary to the accidental ingestion of a dental plate. A diagnosis of perforation was made by CT imaging, but the exact cause could only be determined after resection of the affected bowel and histo-pathological examination. We re-iterate the importance of accurate and thorough history taking in patients with possible foreign body ingestion.     

Intestinal perforation secondary to Salmonella typhi: case report and review of the literature

The case of a young woman presenting with fever, abdominal distention, and diarrhea is presented. While hospitalized, she developed peritonitis, and a laparotomy was performed emergently. Intraoperative and pathologic examinations are highly suggestive of Salmonella typhi as an etiology for her symptoms and eventual perforation. Salmonella enteritis can be a difficult diagnosis to make, but in most cases it is a self-limited disease process. In a minority of cases, multidrug antibiotic therapy may be required secondary to an increasing prevalence of resistant strains. Patients who perforate require prompt operation to limit morbidity and mortality. Outcome is significantly improved in those patients by directed resection of the affected segment of bowel and by aggressive perioperative care.     

A case of prostatic cancer discovered from lung metastatic lesions

We report a case in a 70-year-old patient indicated to have a metastatic lesion from a chest X-ray taken during a medical examination. His blood prostatic specific antigen level was very high at 100 ng/ml (normal, less than 4.0 ng/ml). Palpation of the prostate disclosed enlargement to hen's egg size with an irregular surface and indurations bilaterally. Transrectal sextant needle biopsy of the prostate was performed, revealing moderately differentiated adenocarcinoma. Computed tomography (CT) scan and bone scintigraphy showed intrapelvic lymphnode adenopathy and metastasis to the right pubic bone. Under a diagnosis of stage D2 prostate cancer, we initiated endocrine therapy (luteinizing hormone-releasing hormone analogue depot every 4 weeks and bicalutamide). Androgen blockage was very effective and after 6 months, the PSA level had decreased markedly to below 0.2 ng/ml. Sixteen months later, pulmonary metastasis completely disappeared. He is currently free from recurrence and progressing well.     

A concealed small bowel perforation in an adult secondary to bicycle handlebar trauma

Traumatic abdominal wall hernia (TAWH) secondary to bicycle handlebar is a rare injury. The majority of the literature describes abdominal wall herniation in children. We present a rare case of TAWH in an adult with a concealed small bowel perforation. Although clinical examination in conjunction with computed tomography can exclude the majority of solid organ injuries, small bowel injuries can often be missed. Our case initially revealed a serosal tear in the small bowel but, on close inspection, a separate 3mm perforation was identified, hidden in the small bowel mesentery. We strongly support a low threshold for operative intervention if there is any suspicion. Moreover, we stress the importance of meticulous examination during laparotomy as this injury could have been easily missed, resulting in potential morbidity or mortality in a patient sustaining such an injury.     

Bowel haemorrhage and perforation from metastatic lung cancer. Report of three cases and a review of the literature

Surgical emergencies caused by bowel metastases from carcinoma of the lung are very rare. A search of the English literature revealed less than 10 cases of bowel perforation and no case of haemorrhage. In this report, we describe three patients with both bowel perforation due to metastases from primary lung tumours (one epidermoid; two adenocarcinoma). In two of these, bleeding occurred several days before perforation, suggesting that bowel haemorrhage may be a warning of impending rupture. It may be reasonable to consider early laparotomy to control haemorrhage and prevent perforation even in such patients despite the presence of disseminated malignant disease.     

Abdominal visceral perforation secondary to electrical injury: case report and review of the literature

A patient with a vesico-enteric fistula was successfully treated with resection of the small intestine and dome of the bladder and drainage of the intervening abscess. A search of the literature reveals this to be a very unusual complication of high-voltage electrical injury.     

Chemotherapy for metastatic non-small-cell lung cancer. A case report

The role of chemotherapy for patients with metastatic non-small-cell lung carcinoma (NSCCL) is controversial. A patient with intrathoracic metastatic NSCCL, who was treated by moderate dose cisplatin combination chemotherapy and who remained clinically free of disease more than 5 years after presentation, is described. This treatment has not previously been reported. A trial of moderate-dose cisplatin combination chemotherapy in selected patients with good performance status seems justified.     

Large intestinal perforation secondary to COVID-19: A case report

IntroductionCOVID-19 infection is generally characterized by the presence of respiratory symptoms. However, a small percentage of these patients also have gastrointestinal symptoms and complications that are associated with high morbidity and mortality.Presentation of caseA 50-year-old male patient with COVID-19 infection was being treated for COVID-19 and pneumonia in the ICU. He presented with gastrointestinal symptoms, and the computed tomography (CT) scan revealed a hollow viscus perforation. Ultimately, the patient was taken to surgery, where a spontaneous perforation was found in the right colon. The defect was sutured with separate stitches. There were no complications postoperatively.DiscussionAlthough respiratory symptoms are the most common presentation of COVID-19, about 18% of these patients may present with gastrointestinal symptoms. However, an even smaller percentage of critically ill patients may develop serious gastrointestinal complications such as perforation of the large intestine. This unusual complication requires immediate diagnosis and surgical management.ConclusionAt the time of the COVID-19 pandemic, physicians must recognize COVID-19 in patients presenting gastrointestinal symptoms. A high degree of clinical suspicion enables timely diagnosis and management, thereby preventing major complications.     

Spinal instability secondary to metastatic cancer

Fifty-five patients with severe pain from spinal instability secondary to metastatic cancer were referred to Hope Hospital, none being judged to be in a terminal condition. One patient had too extensive disease for surgery so 54 were treated by 55 spinal stabilisations; 49 obtained complete relief of pain and two had partial relief. There were three failures. Twenty-eight of the patients had clinical evidence of spinal cord or cauda equina compression and were decompressed at the time of stabilisation. Of these, 20 had major recovery of neurological function. Patients with pre-operative evidence of extradural tumour had 'prophylactic' decompression at the time of stabilisation; none of these patients later developed signs of cord or cauda equina compression. The results suggest that alleviation of pain and restoration of mobility are best achieved by segmental spinal stabilisation; a few patients require a combined anterior and posterior stabilisation. Postoperative radiotherapy should be given whenever possible, and the causative tumour should be treated by endocrine or chemotherapy, as indicated.