An atypical presentation of upper urothelial tumor

Although intestinal metastases from extraabdominal malignancies are an infrequent occurrence, they may cause obstruction, visceral perforation, or gastrointestinal bleeding. We report a case of upper gastrointestinal bleeding from a metastasis in the body of the stomach in a 69-year-old man with advanced malignant disease treated by laparoscopic wedge resection. Laparoscopic exploration was undertaken under general anesthesia, confirming the position of the tumor on the greater curve of stomach adjacent to the lower pole of the spleen. The greater curve of the stomach was mobilized with the harmonic scalpel. The gastroepiploic arcade was divided below the tumor, and local resection of the tumor was performed. The specimen was removed in a bag. Postoperatively, the patient made an uneventful recovery and was discharged on the 3rd postoperative day. Histological examination of the specimen indicated choriocarcinoma. We conclude that in selected patients with good functional status, resection of bleeding metastatic lesions of the gastrointestinal tract is a useful palliative procedure. Laparoscopic resection is especially advantageous in patients with a limited prognosis because it shortens postoperative stay and enables early resumption of daily activities.