We report the case of a 48-year-old male smoker (28 packs/year), with no relevant medical history, who came to the emergency department for a clinical picture compatible with intestinal occlusion of one week duration.
She had episodes of severe abdominal pain located in the right iliac fossa, abdominal disk sensation, nausea, vomiting, and difficulty in deposition and wind.
He also complained of diffuse abdominal pain and constitutional syndrome of one month of evolution with anorexia and weight loss of 7 kg.
On physical examination, the abdomen was slightly distended, blunt, depressible, with diffuse discomfort due to more intense irritation in the right iliac fossa, with no signs of peritoneal irritation.
Blood analysis was normal except for slightly elevated inflammatory reaction parameters (leucocytosis 12.900 leuc/mcl, without neutrophilia and CRP 2.4 mg/dl).
In the simple chest X-ray, a new appearance nodule was observed in the upper part of the left lower lobe and in the simple abdominal X-ray, slight dilation of the small intestine loops with air-fluid levels in the orthostatic region.
Abdominal ultrasound revealed an image compatible with invagination of the small intestine.
The study was completed with an abdominal CT that confirmed the diagnosis.
It shows segmental dilation of small bowel loops with image of invagination and thickening of the walls and indeterminate bilateral adrenal nodules without intra or retroperitoneal lymphadenopathies.
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Emergency surgery was decided with the diagnosis of obstructive small bowel invagination.
Postoperative evaluation of the pulmonary nodule was postponed.
The finding of the operation was an ileo-ileal invagination in the middle third of the ileum of approximately 6-7 cm in length, which contained as head of the invagination a fibrous tumor of about 15 cm.
Traffic was restored by functional mechanical lateral-latero-lateral anastomosis.
The postoperative period was uneventful and the patient was discharged 6 days after surgery.
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The pathological diagnosis was intestinal metastasis of pleomorphic polypoid sarcomatoid carcinoma of high grade lung.
Surgical margins free of tumor disease and negative lymph nodes.
Immunohistochemical analysis was negative for C-kitt, DOG-1, S-100 and PDGFR, and positive for TTF-1, AE1-AE3, CK 7, desmin and actin.
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The patient was referred to the emergency department where the primary malignant lung tumor in stage IV was confirmed, with lung, bone and brain dissemination and metastases in both adrenal glands. Treatment with radiotherapy and chemotherapy was indicated.
She received thoracic radiotherapy due to locoregional involvement of the primary tumor, bone analgesic radiotherapy at lumbar, pelvic and holocraneal levels.
She began chemotherapy with CDDP-NVB (cisplatin and navelbin).
After the first three cycles disease progression was detected with the appearance of liver metastases and increase of the rest of the lesions.
It was started with a second-line chemotherapy with docetaxel-gemcitabine.
Survival from diagnosis was 5 months.
