OCCULT GASTROINTESTINAL BLEEDING SECONDARY TO METASTATIC NON-SMALL CELL CARCINOMA OF THE LUNG DIAGNOSED BY CAPSULE ENDOSCOPY

Abstract

Introduction: Small bowel metastasis from primary carcinoma of the lung is an uncommon presentation. Wireless capsule endoscopies have enabled physicians to evaluate and diagnose pathologies of the small bowel, especially occult gastrointestinal bleeding. We report a patient who initially presented with recurrent gastrointestinal bleeding and was later found to have metastatic non-small cell carcinoma of the lung with small bowel metastasis. Case: A 78 year old male presents with several months of recurrent episodes of gastrointestinal bleeding with anemia. The hospital work-up included endoscopy, which revealed a non-bleeding ulcer. A colonscopy demonstrated diverticulosis and a bleeding scan was negative. The patient was treated for shadowing on his chest x-ray, which was thought to be pneumonia. Past medical history is significant for coronary artery disease, myocardial infarction, hypercholesterolemia, benign prostatic hypertrophy and aortic insufficiency. His medications include atenelol, nitroglycerin transdermal, pantoprazole, atorvastatin, niacin, iron, and enalapril. His physical exam was unremarkable. Laboratory results demonstrated anemia. A wireless capsule endoscopy was preformed and demonstrated an ulcerated mass in the distal duodenum, proximal jejunum and redheme. A push enteroscopy was done and the biopsy of the lesion was consistent with metastatic poorly differentiated non-small cell carcinoma. Simultaneously, repeat chest x-ray was done for shortness of breath and a pleural effusion was noted. A thorocentesis was done and the cytology was positive for a similar morphology. Discussion: All types of lung cancer can metastasize to the small bowel, but the Large cell type is the most common. Intestinal lesions are usually found in the jejunum. Clinical manifestations may include perforation, obstruction or hemorrhage. Prior to this report there have been 15 cases of gastrointestinal hemorrhage secondary to small bowel metastasis from primary lung cancer. The capsule endoscopy is proving a useful diagnostic tool for evaluating pathologies of the small bowel.