A case of perforation intrachemotherapy for stage iv lung cancer

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 69; no. 7; pp. 1651 - 1654
• Main Authors: ITO, Hiromichi, KATO, Akinori, NOZAKI, Reiji, YODONAWA, Satoshi, OGAWA, Isao
• Format: Journal Article
• Language: English
• Published: Japan Surgical Association 2008
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.69.1651

A 72-year-old man visited our hospital because of cough and right inguinal swelling was performed radical operation with a diagnosis of right inguinal hernia, when ascites was identified. The cytologic diagnosis of the ascites was non-small cell carcinoma and peritonitis carcinomatosa was clarified. Following close exploration, Stage IV non-small cell carcinoma of the left lung was diagnosed. One course of chemotherapy with carboplatin and paclitaxel yielded a decrease of the primary lesion in size. However, abdominal pain developed on the 11th day after the regimen and an abdominal x-ray film showed free air. General peritonitis due to perforation of the digestive tract was suggested and laparotomy was performed on the same day. A 3 × 2cm metastatic lesion was confirmed in the upper portion of the jejunum, of which center part became necrotic and perforated. Three other metastatic lesions were present in the small intestine. Partial resection of the small intestine including all lesions was performed. The chemotherapy was scheduled to resume after the operation, however, the pulmonary lesion progressed, the patient's general condition deteriorated, and the patient died on the 18th hospital day. Cases of lung cancer metastasized to the small intestine are often encountered, but such cases causing perforation are rare. Careful observation of clinical course would be mandatory during treatment of lung cancer associated with intra-abdominal metastasis by keeping a possibility of gastrointestinal perforation in mind.