Infarction and Perforation of the Small Intestine due to Tumor Emboli from Disseminated Rectal Cancer

• Published in: Gut and liver Vol. 2; no. 2; pp. 130 - 132
• Main Authors: Jo, Jae-Cheol, Lee, Dae Ho, Song, Ho June, Kim, Sang-We, Suh, Cheolwon, Kang, Yoon-Koo
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Gastroenterology; the Korean Society of Gastrointestinal Endoscopy; the Korean Association for the Study of the Liver; the Korean Society of Neurogastroenterology and Motility; Korean Association for the Study of Intestinal Diseases; Korean College of Helicobacter and Upper Gastrointestinal Research; Korean Society of Pancreatobiliary Diseases 01.09.2008; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: Case Report; infarction; intestinal perforation; rectal cancer; small intestine; tumor embolism; 내과학; Tumor embolism; Infarction; Rectal cancer; Intestinal perforation; Small intestine
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl.2008.2.2.130

Small bowel perforation due to hematogenous metastatic tumor emboli is a rare event, especially in a patient with rectal cancer. We report a 75-year-old man with relapsed rectal cancer who developed an acute abdomen, which was found to be due to a perforated terminal ileum. Emergency surgery involved segmental resection and ileostomy. The pathology of the resected small bowel showed multifocal and extensive metastatic tumor emboli in the entire wall, leading to transmural infarction followed by perforation, without a discrete tumor mass. The pathology with immunohistochemistry showed a rectal tumor that was positive for CK-20 but negative for CK-7 and TTF-1. This extremely rare complication of rectal cancer resulted from ischemia and infarct caused by disseminated metastatic tumor emboli without direct invasion or mass formation.