Abstract:Renal cell carcinoma (RCC) may metastasize to almost any organ, but metastasis to the small bowel is rare. Small bowel metastasis from RCC can induce obstruction or bleeding, and perforation can also be induced in rare case. Yet RCC metastasis to the small bowel is unlikely to be a direct cause of intussusceptions. A few cases of intussusceptions caused by small intestinal metastasis of RCC have been reported, but multiple small intestinal intussusceptions are extremely rare. We report here on a 47-year-old ma… Show more
“…Preoperative diagnosis of intussusception is difficult. CT is the most useful diagnostic procedure [ 8 ]. Other diagnostic tools such as upper gastrointestinal series, colonoscopy and flexible sigmoidoscopy are frequently non-diagnostic [ 7 , 9 ].…”
Section: Discussionmentioning
confidence: 99%
“…The management of adult intussusception remains controversial, although metastasectomy may extend patient survival [ 5 ]. Thus, surgical resection of the involved intestinal segment has been recommended as the treatment of choice [ 8 ]. Figure 4: Dimple formation on the serosa due to traction of the tumour.…”
We report on a 61-year-old man who was referred to the accident and emergency department with recurrent episodes of vomiting and diffuse abdominal pain for 1 week prior to admission. The patient also reported frequent constipation and intermittent melaena. He had undergone tumour nephrectomy for metastatic renal clear cell carcinoma 3 years before and had received sequential vascular endothelial growth factor receptor and mammalian target of rapamycin-targeted therapies. The abdominal computed tomography scan showed small bowel obstruction due to triple intussusception of the proximal jejunum and several large intra-luminal tumour masses. Intra-operative findings were five intramural masses 15 cm distal to the ligament of Treitz over a total length of 50 cm. A primary en bloc resection with an end-to-end anastomosis was carried out. The postoperative course was uneventful.
“…Preoperative diagnosis of intussusception is difficult. CT is the most useful diagnostic procedure [ 8 ]. Other diagnostic tools such as upper gastrointestinal series, colonoscopy and flexible sigmoidoscopy are frequently non-diagnostic [ 7 , 9 ].…”
Section: Discussionmentioning
confidence: 99%
“…The management of adult intussusception remains controversial, although metastasectomy may extend patient survival [ 5 ]. Thus, surgical resection of the involved intestinal segment has been recommended as the treatment of choice [ 8 ]. Figure 4: Dimple formation on the serosa due to traction of the tumour.…”
We report on a 61-year-old man who was referred to the accident and emergency department with recurrent episodes of vomiting and diffuse abdominal pain for 1 week prior to admission. The patient also reported frequent constipation and intermittent melaena. He had undergone tumour nephrectomy for metastatic renal clear cell carcinoma 3 years before and had received sequential vascular endothelial growth factor receptor and mammalian target of rapamycin-targeted therapies. The abdominal computed tomography scan showed small bowel obstruction due to triple intussusception of the proximal jejunum and several large intra-luminal tumour masses. Intra-operative findings were five intramural masses 15 cm distal to the ligament of Treitz over a total length of 50 cm. A primary en bloc resection with an end-to-end anastomosis was carried out. The postoperative course was uneventful.
“…The management of adult intussusception remains controversial; however, metastasectomy may extend patient survival (34). Therefore, surgical resection of the involved intestinal segment has been recommended as the treatment of choice (35,36). The diagnosis of intussusception is complex, but in the majority of cases CT allows the diagnosis of the presence of an intraluminal soft-tissue density within the lumen of the bowel, the intussuscepted hernia, referred to as the 'target' sign, which is associated with the presence of eccentric mesenteric fat and vessels and is considered a pathognomonic sign of intussusception on CT images (37).…”
Abstract. Renal cell carcinoma (RCC) may metastasize to almost any organ, but bowel metastases are highly unusual. A 75-year-old man presented with symptoms and signs of severe anaemia due to bowel bleeding and abdominal pain due to recurrent bowel intussusception. The patient underwent surgery and was identified to have intraluminal metastases from metastatic RCC. To the best of our knowledge, few cases of metastases from RCC manifesting as synchronous intraluminal polypoid tumours have been described in the literature. The present report focused on the importance of two aspects that must be considered: The role of accurate diagnosis and of surgery treating intestinal metastases that may lead to symptom control and prolonged survival.
IntroductionRenal cell carcinoma (RCC) is a common malignancy, of which there were ~12,600 cases in 2015 in Italy (1). It represents 3% of all adult malignancies in this region, and is the third most frequent urologic malignancy after prostate and bladder cancer (2). RCC accounts for 90% of kidney cancer cases, and ~80% of these are clear cell carcinomas (3,4). The majority of cases of renal cancer are asymptomatic and are diagnosed incidentally, due to more extensive use of diagnostic imaging, whereas the classic triad of haematuria, flank pain and palpable abdominal mass are rarely the first symptoms of presentation, occurring in 4-17% of cases (5,6).On occasion, the symptoms occurring due to the presence of intestinal metastasis may be the first presentation of renal cancer (7,8). These symptoms usually include nausea, abdominal pain, intussusception, weight loss, melena, bowel perforation, and primarily, gastrointestinal bleeding caused by the infiltration of intestinal vessels (9).The current study presents the case of a 75-year old male in which severe anaemia due to bowel bleeding and abdominal pain from recurrent bowel intussusceptions were the first presentations of metastatic renal cell carcinoma. A review of the cases of bowel metastasis from renal cell carcinoma described in the literature from 2006 to the present was also conducted (Table I). Written informed consent was obtained from the patient for the publication of this case report and accompanying images.
Case presentationIn February 2014, a 75-year old male presented to San Paolo Hospital (Naples Italy) emergency department with symptoms and signs of severe anaemia: Tachycardia, pallor, fatigue and hypotension. The patient's medical history was relevant for chronic gastritis, prostate cancer, diabetes mellitus and Parkinson's disease, recurrent abdominal pain and constipation. Laboratory tests revealed severe anaemia (haemoglobin level, 5.6 g/dl, normal range 14-18 g/dl) that required a transfusion of packed red blood cells. At rectal examination, tarry stools compatible with melena were evident and an esophagogastroduodenoscopy was performed, but was negative for bleeding lesions. Abdominal ultrasound revealed the presence of a lesion of 35 mm in the lower pole of the left kidney suspicious for a neoplastic les...
“…Though solitary duodenal metastasis has been reported, duodenal metastasis in the setting of widespread nodal and visceral involvement has been found to be more common [6]. Duodenal metastasis has been reported to present with varied clinical presentations including abdominal pain, anemia, gastrointestinal bleeding, duodenal obstruction, or intussusception [5, 7, 8]. On endoscopy these lesions can be seen as polypoid mass, nodules, or submucosal mass with ulceration [9].…”
Renal cell carcinoma (RCC) has potential to present with distant metastasis several years after complete resection. The common sites of metastases include the lungs, bones, liver, renal fossa, and brain. RCCs metastasize rarely to the duodenum, and duodenal metastasis presenting with acute gastrointestinal bleed is infrequently reported in literature. We present a case of synchronous presentation of duodenal and azygoesophageal metastasis manifesting as acute upper gastrointestinal bleeding, four years after undergoing nephrectomy for RCC. The patient underwent further workup and was treated with radiation. The synchronous presentation is rare and stresses the importance of searching for recurrence of RCC in patients presenting with acute gastrointestinal bleeding.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
