Colonic metastasis from infiltrating ductal breast carcinoma in a male patient: A case report.

INTRODUCTION: A colonic metastasis from infiltrating breast ductal carcinoma is a rare phenomenon in the literature, especially in a male. PRESENTATION OF CASE: We present a rare case of a 55-year-old male with a past medical history of breast cancer who presented with signs and symptoms of appendicitis. A computed tomography (CT) scan revealed acute appendicitis in addition to a 2.3 cm cecal mass that correlated with a hypermetabolic region on positron emission testing (PET) the previous year. Analysis of a previously biopsied axillary lymph node demonstrated infiltrating ductal carcinoma. After an appendectomy and a right hemicolectomy were performed, pathologic analysis of the specimen revealed metastatic ductal carcinoma to the cecum. DISCUSSION: Gastrointestinal metastases of breast carcinoma are rare with colonic metastases occurring in approximately 3% of these cases. At the time of diagnosis of these colonic metastases, the disease is often times multifocal in the gastrointestinal tract. Solitary gastrointestinal metastases are less common than both secondary primaries and benign processes. Biopsies obtained during colonoscopy are often non-diagnostic, mandating surgical excision and pathologic examination. CONCLUSION: Although colonic metastases from a primary breast ductal carcinoma are rare, a low level of suspicion must be maintained in a patient with such a history presenting with abdominal symptoms.

A unique case report of jejunoileal bypass reversal with review of the literature.

INTRODUCTION: Jejunoileal bypass (JIB) was an effective treatment for morbid obesity in the 1970s, but shortly after it fell out of favor due to horrific side effects, including liver failure, nephrolithiasis and drastic vitamin deficiencies. Although there are few living people with JIB, the management of these patients can be challenging. CASE PRESENTATION: We describe a case of a 58-year-old female with a history of JIB 46 years prior who had an impending renal failure due to nephrolithiasis. She underwent a jejunostomy feeding tube prior to reversal. After reversal, our patient developed failure to thrive with functional obstruction of the newly incorporated small bowel. This bypassed bowel underwent a severe inflammatory transformation after the introduction of enteric feeds, suggesting an immunological type response to antigens in food. It wasn't until a long and debilitating 12 months and resection of this inflamed bowel that our patient was able to regain bowel function and gain weight. CONCLUSION: Jejunoileal bypass is an archaic procedure for morbid obesity. Due to its debilitating and at times lethal side effects, it has been replaced with newer techniques. Despite advances, there are still patients out there who have had a jejunoileal bypass. This case report and review of the literature details our experience with this procedure.