Intra-abdominal metastases from primary carcinoma of the lung.

The case of a 56-year old male with an intra-abdominal metastasis from a primary lung cancer is presented. He was admitted for abdominal obstruction, toxic syndrome and paraumbilical pain. He had a previous history of squamous cell carcinoma of the right lung, for which he had undergone a right upper lobectomy in 1995, four years prior to the development of the abdominal obstruction. A debulking operation and bowel resection for the intestinal metastasis was performed. Eleven months after this operation the patient developed a recurrence: he underwent another debulking operation with resection of the sigmoid colon, jejunal segment and a small part of the bladder. The patient is alive and well 13 months after the initial operation. Intra-abdominal metastases of bronchial carcinoma may be observed with greater frequency, because of the improved survival of the patients with lung cancer. Metastatic small bowel carcinomas are rare and should be considered in the differential diagnosis of acute abdominal syndromes of patients with known history of the lung cancer. Bowel resection and debulking of the metastatic tumour mass give the best palliation and improve short-term survival.

Intramural duodenal hematoma of pancreatic origin.

Non-traumatic intramural hematoma of the duodenum is an unusual clinical entity. Indeed, in a majority of 70% of patients intramural hematoma of the duodenum is caused by a blunt, frequently minor abdominal trauma. The main etiology of non-traumatic intramural hematoma of the duodenum in the adult is overdose anticoagulant therapy. Rarer causes include pancreatic disease, blood dyscrasia or vascular collagen disease. In this presentation a case of pancreatitis-induced intramural duodenal hematoma is discussed and compared with corresponding data in the literature.

[Gastrocolic and gastrojejunocolic fistulas. 6 cases]. / Gastrocolische en gastrojejunocolische fistels. Zes observaties.

On occasion of the observation of five peptic gastrojejunocolic fistulae and of one gastrocolic fistula by Crohn's disease, the authors analyse the etiopathogenesis and the pathophysiology of this rare complication in the light of recent advances of the literature.