Gastrointestinal dysmotility in a patient with advanced lung cancer: paraneoplastic or drug-induced?

• Published in: BMJ case reports Vol. 14; no. 1; p. e237835
• Main Authors: Dias, Raphael Figuiredo, Diniz, Mirella Monique Lana, Santos, Bruno Campos, Nobre, Vandack Alencar
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 26.01.2021; BMJ Publishing Group
• Subjects: Abdomen; Aged; Analgesics; Antiemetics - therapeutic use; Blood; Cancer therapies; Carcinoma, Squamous Cell - complications; Carcinoma, Squamous Cell - diagnostic imaging; Case Report; Case reports; Constipation; Constipation - diagnosis; Constipation - drug therapy; Constipation - etiology; Constipation - physiopathology; Contrast agents; Dyspnea; Gastrointestinal Agents - therapeutic use; Gastrointestinal Diseases - diagnosis; Gastrointestinal Diseases - drug therapy; Gastrointestinal Diseases - etiology; Gastrointestinal Diseases - physiopathology; Gastrointestinal Motility; Gastroparesis - diagnosis; Gastroparesis - drug therapy; Gastroparesis - etiology; Gastroparesis - physiopathology; Glycerol - therapeutic use; Humans; Lactulose - therapeutic use; Lung cancer; Lung Neoplasms - complications; Lung Neoplasms - diagnostic imaging; Male; Malnutrition; Metoclopramide - analogs & derivatives; Metoclopramide - therapeutic use; Morphine; Morphine - adverse effects; Narcotics; Nausea; Opioid-Induced Constipation - diagnosis; Pain; Palliative Care; Paraneoplastic Syndromes, Nervous System - diagnosis; Paraneoplastic Syndromes, Nervous System - etiology; Paraneoplastic Syndromes, Nervous System - physiopathology; Patients; Pulmonary arteries; Quality of life; Stomach; Tramadol - adverse effects; Veins & arteries; Pain (palliative care); End of life decisions (palliative care); Gastrointestinal system; Lung cancer (oncology)
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-237835

A 75-year-old man was hospitalised for bronchoscopy with biopsy due to a suspicious pulmonary mass at chest tomography. He had significant dyspnoea, constipation, nausea, vomiting, anorexia and a 33% loss of weight in the past 3 months. Biopsy revealed a pulmonary squamous cell carcinoma, which was inoperable. Tramadol used at home for 3 months was replaced by morphine on admission. The patient remained constipated despite prokinetics and laxatives, leading to the diagnostic hypothesis of paraneoplastic motility disorder and opioid-induced constipation. Abdominal tomography ruled out the possibility of mechanical obstruction. As complications, the patient presented superior vena cava syndrome and opioid (morphine) intoxication. The patient died a few days later. The management of this case highlights the importance of multidisciplinary care and the challenges of palliative oncology care. Paraneoplastic motility disorder must always be considered among the mechanisms of intestinal dysfunction in patients with advanced oncological disease.