Acute Appendicitis and Small Bowel Obstruction Secondary to Metastatic Breast Cancer

Abstract

Breast cancer is the most common cancer in women; it is well-known to metastasize to lymph nodes, lungs, liver, brain, and bones. However, luminal gastrointestinal metastasis is rare, especially to the appendix. Herein, we report a case where cancer metastasized to the ileum and appendix, causing acute appendicitis and small bowel obstruction. This is a 44-year-old female with a history of stage IV metastatic breast cancer to bones, lungs, and ovaries, presented with acute abdominal pain for one day. Her abdomen was soft, distended with generalized tenderness. Computed tomography (CT) of the abdomen and pelvis showed a partial small bowel obstruction and swollen appendix. After her symptoms worsened on conservative treatment, she was taken to the operating room where she was found to have a markedly dilated ileum with signs of acute appendicitis, so she underwent ileocecectomy, appendectomy, and lysis of adhesions. Pathology showed metastatic breast cancer in the appendix with findings consistent with acute appendicitis. She tolerated surgery well without complications. In conclusion, small intestinal and appendiceal metastases of breast cancer are very rare though they should be considered in the differential diagnosis in cancer patients presenting with acute abdominal pain.

Acute appendicitis secondary to metastatic breast cancer. 12 Years after first primary tumor diagnosis. A case report

“…A literature review reveals only 16 prior cases of MBC with the involvement of the appendix. Most patients underwent appendectomy (10/16) [14] .…”

Acute Appendicitis Secondary to Metastatic Malignancy - A Review of 78 Cases in Literature

“…Seventeen cases [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] of metastatic breast cancer causing appendicitis were identified. The age of the patients ranged from 35 up to 90 years old, with an average age of 54 years old.…”

“…58.8% of the cases were complicated compared to 41.2% of uncomplicated appendicitis. Four cases were metastatic lobular carcinoma [10,12,18,20] and eleven cases were metastatic ductal carcinoma. One patient had ileocecectomy due to findings of dilated ileum intraoperatively along with oedematous appendix [10].…”

“…Four cases were metastatic lobular carcinoma [10,12,18,20] and eleven cases were metastatic ductal carcinoma. One patient had ileocecectomy due to findings of dilated ileum intraoperatively along with oedematous appendix [10]. Bilateral oophorectomy was performed on one of the patients because a clinically pathological ovary was identified intraoperatively and it contained metastatic carcinoma [13].…”

“…Numan Et al[10] (2019)ER+/PR+/HER2 (-) Invasive Lobular Citation: Chang W, Goodall K, Ong S, Lawson J, Ng J (2023) Acute Appendicitis Secondary to Metastatic Malignancy -A Review of 78 Cases in Literature. J Surg 8: 1757 DOI: 10.29011/2575-9760.001757 Volume 08; Issue 05 J Surg, an open access journal ISSN: 2575-9760Dirksen et al[18] (2010)…”