Acute Gastrointestinal Bleeding: A Report of Rare Presentation of Duodenal Metastasis From Cervical Squamous Cell Carcinoma

Feroza Patel,Syed Atif,Abdul Waheed,Trajan Barrera,Erum Azhar

doi:10.7759/cureus.16245

Abstract

We report a case of a 42-year-old gravida 3, para 4 woman from Puerto Rico with a history of cervical cancer who presented with dizziness, lethargy, and three days of bright red blood per rectum. Imaging evaluation showed a retroperitoneal lymph node mass with secondary metastasis to the duodenum. After she was stabilized with multiple blood transfusions and to mitigate her ongoing bleeding, she was transferred to a tertiary care hospital for possible embolization by interventional radiologists. However, she was deemed a poor candidate for an interventional procedure and decided to ultimately go home on hospice care. This case highlights the rarity of duodenal metastasis presenting as gastrointestinal bleeding due to cervical squamous cell cancer and further reinforces the need for human papillomavirus vaccination and cervical cancer screening. This case study also illustrates that even though cervical cancer rates are low in the United States, it is still deadly in many countries across the globe. As people continue to travel and migrate across borders, the risk of being lost to follow-up is on the rise.

Highlights

Cancer is the second leading cause of death in the United States [1], with cervical cancer previously being one of the leading causes of death for American women
The gastrointestinal (GI) tract has been reported to be involved in approximately 8% of all cervical carcinomas, but in most of those cases, the colon was usually involved through lymphatic spread or local invasion
Metastasis to a distant site is rare and most commonly occurs via the lymphatic spread, hematogenous spread may occur in approximately 5% of patients

Summary

Introduction

Cancer is the second leading cause of death in the United States [1], with cervical cancer previously being one of the leading causes of death for American women. In May 2020, a 42-year-old gravida 3, para 4 female originally from Puerto Rico with a past medical history of systemic lupus erythematosus, expressive aphasia secondary to lupus cerebritis in her 20s, and metastatic squamous cell cervical cancer presented to the Emergency Department with three days of progressive dizziness, light-headedness, and bloody bowel movements with hematochezia She denied head trauma, falls, vaginal bleeding, hematemesis, or melena, straining, or pain with defecation. Since moving to Pennsylvania in February 2020, she established care locally with Hematology-Oncology and Gynecology-Oncology services She was found to have confirmed FIGO stage 3B cervical cancer, a retroperitoneal lymph node mass, and secondary spread to the duodenum (Figure 1). Imaging with CT abdomen and pelvis showed a growing retroperitoneal mass that was noted to be larger compared to her earlier imaging studies done in February 2020 (Figure 2) She was stabilized in the Emergency Department with one unit of packed red blood cells, 2 L of normal saline, and oral pantoprazole. She succumbed to her metastasis within six weeks of going home under the care of her outpatient hospice physician

Discussion

Conclusions

Disclosures

Findings

Gallup DG