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This case report describes a 67-year-old female presenting with malignant gastroparesis secondary to metastatic transverse colon cancer. During exploratory laparotomy, biopsy of a small bowel nodule revealed focal benign glandular epithelial inclusions consistent with endometriosis, which co-existed with the malignancy. The authors note that while endometriosis is rare in postmenopausal women, it can cause intestinal obstruction through inflammation or fibrosis and shares risk factors with ovarian cancer, necessitating biopsy to exclude malignancy. Relevance to endometriosis: listed as a co-existing condition identified incidentally during surgery for colon cancer, though the paper's main focus is on malignant gastroparesis.
Abstract
Paraneoplastic syndromes rarely involve neurological system including neuronal bodies of the gastrointestinal (GI) tract and can present as gastroparesis. We are presenting a case of malignant gastroparesis in a patient with underlying colon cancer. A 67-year-old female with the history of schizophrenia, gastric outlet obstruction status post gastrojejunostomy with vagotomy presented with progressive abdominal distension for 2 months, associated with abdominal pain, and vomiting. Labs including liver functions and lipase were unremarkable. CT abdomen showed antrum wall thickening with the distended stomach. Upper GI series was consistent with gastroparesis. Endoscopy was performed due to persistent gastric outlet obstruction which showed patent gastrojejunal anastomosis. Biopsy of the pylorus and gastric antrum showed signs of chronic inflammation. The patient was unable to tolerate liquid diet. Exploratory laparotomy was performed, jejunostomy feeding tube was inserted, and biopsies of gastric wall and small bowel nodule were done. Diagnosis of transverse colon cancer was made at the time of surgery. A portion of transverse colon was resected followed by anastomosis and colostomy placement. Biopsy of gastric wall showed chronic gastritis and small bowel nodule biopsy showed focal benign glandular epithelial inclusions consistent with endometriosis. The patient was started on jejunostomy tube feeding which she tolerated well. Gastroparesis is characterized by decreased gastric motility in the absence of any mechanical obstruction. The condition is seen with diabetes mellitus, Parkinson disease, use of opiates and post-surgical patients. It is underdiagnosed in cancer patients, especially in upper GI malignancies. Endometriosis is commonly seen in reproductive age and rarely seen in postmenopausal women. Endometriosis can cause intestinal obstruction by localized inflammation, fibrosis or direct obstruction. Our case is rare as the patient had malignant gastroparesis with underlying metastatic colon cancer and coexisting small bowel endometriosis. Gastroparesis was refractory after surgery. The presentation also caused the delay in diagnosis of underlying malignancy. Investigations should include CT scan abdomen and upper endoscopy. The test of choice is gastric scintigraphy. Gastroparesis can be an initial manifestation of occult malignancy. Endometriosis and ovarian cancer share same risk factors, so malignancy must be excluded by biopsy of nodules
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Paraneoplastic syndromes rarely involve neurological system including neuronal bodies of the gastrointestinal (GI) tract and can present as gastroparesis. We are presenting a case of malignant gastroparesis in a patient with underlying colon cancer. A 67-year-old female with the history of schizophrenia, gastric outlet obstruction status post gastrojejunostomy with vagotomy presented with progressive abdominal distension for 2 months, associated with abdominal pain, and vomiting. Labs including liver functions and lipase were unremarkable. CT abdomen showed antrum wall thickening with the distended stomach. Upper GI series was consistent with gastroparesis. Endoscopy was performed due to persistent gastric outlet obstruction which showed patent gastrojejunal anastomosis. Biopsy of the pylorus and gastric antrum showed signs of chronic inflammation. The patient was unable to tolerate liquid diet. Exploratory laparotomy was performed, jejunostomy feeding tube was inserted, and biopsies of gastric wall and small bowel nodule were done. Diagnosis of transverse colon cancer was made at the time of surgery. A portion of transverse colon was resected followed by anastomosis and colostomy placement. Biopsy of gastric wall showed chronic gastritis and small bowel nodule biopsy showed focal benign glandular epithelial inclusions consistent with endometriosis. The patient was started on jejunostomy tube feeding which she tolerated well. Gastroparesis is characterized by decreased gastric motility in the absence of any mechanical obstruction. The condition is seen with diabetes mellitus, Parkinson disease, use of opiates and post-surgical patients. It is underdiagnosed in cancer patients, especially in upper GI malignancies. Endometriosis is commonly seen in reproductive age and rarely seen in postmenopausal women. Endometriosis can cause intestinal obstruction by localized inflammation, fibrosis or direct obstruction. Our case is rare as the patient had malignant gastroparesis with underlying metastatic colon cancer and coexisting small bowel endometriosis. Gastroparesis was refractory after surgery. The presentation also caused the delay in diagnosis of underlying malignancy. Investigations should include CT scan abdomen and upper endoscopy. The test of choice is gastric scintigraphy. Gastroparesis can be an initial manifestation of occult malignancy. Endometriosis and ovarian cancer share same risk factors, so malignancy must be excluded by biopsy of nodules
Abstracts: ACCEPTED: CLINICAL VIGNETTES/CASE REPORTS—STOMACH
Malignant Gastroparesis With Underlying Colon Cancer and Co-existing Endometriosis
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- Waseem Amjad
- May Kyaw
- Sophia Jagroop
American Journal of Gastroenterology 112:p S1380, October 2017.
Copyright © The American College of Gastroenterology 2017. All Rights Reserved.
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