An 83-year-old woman with vascular risk factors (hypertension and dyslipemia).
Tubular adenomas were the most frequent etiologies.
She had undergone surgery for tonsils, appendix and abdominal incisional hernia.
His deceased daughter after 52 years of gastric cancer stood out as family history.
She came to the emergency department with a one-month history of persistent abdominal pain in the upper hemiabdomen and postprandial periumbilical region, associated with nausea without vomiting.
The patient had an intestinal rhythm with a tendency to exacerbated constipation during that period.
He also had anorexia and loss of consciousness of 7kg.
She was being treated with: artilog 200 mg 0-1-0, enalapril 20 mg 1-0-0-0, nerdipine 20 mg 1-0-1, pantoprazole 40 mg 1-0-0, simvastatin 10 mg 0-0-1, and
Physical examination revealed: blood pressure 120; heart rate 81 beats/min Afebril.
Regular general condition
The patient was well hydrated and pale mucocutaneous.
Left supraclavicular node, hard to fix, mobile, non-painful.
Cardiac arrest was normal.
Pulmonary consolidation was normal.
Abdomen blando, of presible, painful to the deep fixation in hemiabdomen and periumbilical, without masses or enlargement, decreased peristalsis.
Lower extremities without edema or signs of deep venous thrombosis.
Chest X-ray: 2 cm pulmonary nodule in LSD.
ECG: sinus rhythm at 86 beats/min. Blood analysis: microcytic anemia (Hb: 10 g/dl (11.9-16.5), MCV: 77.42-99.4).
Leukocytosis with neutrophilia (20,000 leukocytes/ml (3.5-10.5) with 84% neutrophils-73).
VSG 67 mm/h (2-10).
PCR 150 mg/l (0-10).
The analytical study was completed with a complete iron profile: serum iron 14 μg/dl authenticate-145 implicates μg/dl), transferrin saturation index 15% (20-50%) and ferritine 463 ng/ml.
Thinking arthritis antigen (CEA) was also determined in malignant gastrointestinal neoplasms and anti-transglutaminase antibodies, with normal values.
Persistence of abdominal pain requiring intravenous opioids was determined by abdominal ultrasound, which showed pathologically sized pelvic lymphadenopathy, compile the study with computerized axial tomography (CAT) ab.
The CT scan showed a mural thickening of a proximal small intestine segment of about 4.4 cm in diameter accompanied by multiple adenopathies with a hypodense center.
An antegrade enteroscopy was performed, observing the Treitz angle, polypoid formation with ulceration of about 15 mm in diameter, from which biopsies were taken.
4 cm thick, proximal and pylorus; biopsies of a ulcerated neoformation were taken
About 30 cm of pylorus was observed another ulcerated, rigid area, about 2 cm in diameter that was biopsied (C).
1.
Histological analysis was consistent with jejunal metastases from poorly differentiated carcinoma.
Both morphology and immunophenotype were compatible with large cell lung carcinoma.
Immunophenotype: cytokeratin AE1-AE3: (+); S100, HMB 45: (-); cytokeratin 20: (-), cytokeratin 7: (+); n TTF1:
A chest CT scan showed a solid pulmonary nodule with a spiculated appearance at the right apex of 2.6 cm, with pleural contact, mediastinal adenopathies in the upper and lower bronchial paratracheal compartments and in the upper and lower bifurcations.
Bilateral supraclavicular adenopathies.
1.
Given the patient's age and advanced stage of the disease and the presentation of CD 3, palliative treatment was decided, and the patient died 22 days after hospital discharge.
