S3461 Duodenal Metastasis of Stage 4 Lung Cancer Leads to Massive GI Bleed and Death

Abstract

INTRODUCTION: Lung cancer is a leading cause of death worldwide. The most common locations of metastasis are adrenal glands, liver, brain, and kidneys, less frequently to the gastrointestinal tract. The outcome is inferior as distant metastasis is always found at the time of diagnosis. In this case report, we present a patient with gastrointestinal bleeding due to Stomach and duodenal metastasis. CASE DESCRIPTION/METHODS: A 74-year-old man with a past medical history of stage 4 metastatic lung cancer with the brain ,lumbar spine and local lymph nodes metastasis presented to the emergency department with a four-day history of generalized weakness and black tarry stools. The patient was admitted to the step-down floor was resuscitated with IV fluids and blood transfusion started on Protonix drip and were kept NPO. Endoscopic evaluation was remarkable for a small clean based gastric and large clean based ulcer in the duodenal bulb, in the second portion of the duodenum polypoid mass with friable tissue with oozing was noted, a hemoclip was placed for possible embolization adjacent to the lesion, 4 additional friable masses 2–4cm in size extended into the 3rd portion of the duodenum biopsies were obtained with results showing poorly differentiated carcinoma. The patient was continued on high dose PPI but developed hematemesis with hemodynamic instability and after discussion with family comfort care measures were initiated and the patient passed. DISCUSSION: Gastrointestinal tract involvement in lung cancer is less frequent and mostly found in the advanced stages of the disease ranging from 0.5 to 14 % of cases. Autopsy studies have shown a much higher incidence as compared to clinical studies. The small bowel is the most common location of GI metastasis for all the histological types of primary lung cancer. EGD is the most common diagnostic modality. Due to very vague symptoms, EGD is not very commonly performed. It would be appropriate to perform screening endoscopy to all metastatic lung cancer patients with non-specific GI symptoms to rule out early metastasis. In conclusion, gastrointestinal metastasis predicts a stern prognosis in most lung cancer patients. The primary recommendation is palliative treatment in the setting of multiple organ metastasis.Figure 1.: Duodenal Bulb Ulcer.Figure 2.: Friable Polypoid lesion in the second portion of the duodenum.Figure 3.: Masses extending into the 3rd portion of the duodenum.