Intest Res.  2017 Jan;15(1):130-132. 10.5217/ir.2017.15.1.130.

Capsule retention caused by duodenal metastases from primary appendiceal adenocarcinoma

• Chou JW
• Cheng KS

• KMID: 2368496
• DOI: http://doi.org/10.5217/ir.2017.15.1.130

Abstract

Metastatic small bowel cancers are extremely rare in clinical practice. Primary appendiceal adenocarcinoma with gastrointestinal metastasis is seldom reported in the literature. Here, we describe the case of an 80-year-old male patient with primary appendiceal adenocarcinoma, who presented to China Medical University Hospital with mid-gastrointestinal tract bleeding. Capsule endoscopy revealed stenotic bowel lumen, but the capsule was retained in the distal duodenum. Double-balloon enteroscopy demonstrated erosive and erythematous mucosa in the region of capsule retention. The retained capsule was retrieved successfully by using an electrosurgical snare. Histological examination and immunohistochemical staining of the biopsy specimen from the duodenal lesion strongly supported the diagnosis of metastatic appendiceal adenocarcinoma.

Keyword

Primary appendiceal adenocarcinoma; Metastatic small bowel cancer; Capsule endoscopy; Capsule retention; Double-balloon enteroscopy

MeSH Terms

Adenocarcinoma*
Aged, 80 and over
Biopsy
Capsule Endoscopy
China
Diagnosis
Double-Balloon Enteroscopy
Duodenum
Hemorrhage
Humans
Male
Mucous Membrane
Neoplasm Metastasis*
SNARE Proteins
SNARE Proteins

Figure

• 

  Fig. 1 Abdominal CT finding. CT revealed multiple enlarged preaortic lymph nodes (arrows).

• 

  Fig. 2 Enteroscopic finding. Antegrade double-balloon enteroscopy demonstrating a retained capsule in the stenotic duodenal lumen.

• 

  Fig. 3 Enteroscopic finding. Erosive and erythematous mucosa were identified in the stenotic lumen of the duodenum during double-balloon enteroscopy.

• 

  Fig. 4 Pathologic finding. Histopathological section of a biopsy specimen showing poorly differentiated metastatic adenocarcinoma (arrows) (H&E, ×100).

Reference

1. Gill SS, Heuman DM, Mihas AA. Small intestinal neoplasms. J Clin Gastroenterol. 2001; 33:267–282. PMID: 11588539.

2. Ko YH, Jung CK, Oh SN, et al. Primary signet ring cell carcinoma of the appendix: a rare case report and our 18-year experience. World J Gastroenterol. 2008; 14:5763–5768. PMID: 18837098.

3. Thoma MN, Saiyed SM, Charles RJ. Metastatic colorectal cancer to the small bowel-an uncommon cause of obscure GI bleeding: a three-case experience with review of the literature. J Gastrointest Cancer. 2011; 42:119–122. PMID: 20658210.

4. Miyashita T, Hoshino E, Imamura T, Okinaga K, Akaoka I, Miyashita H. A case of appendiceal cancer metastatic to the stomach with pseudomyxoma peritonei. J Gastroenterol. 1994; 29:71–75. PMID: 7515309.

5. Yoshida R, Yoshioka K, Yoshitaka H, et al. Pseudomyxoma peritonei of appendiceal cancer with metastasis to the stomach: report of a case. Surg Today. 2002; 32:547–550. PMID: 12107784.

6. Schwartz GD, Barkin JS. Small-bowel tumors detected by wireless capsule endoscopy. Dig Dis Sci. 2007; 52:1026–1030. PMID: 17380403.

7. Yamamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001; 53:216–220. PMID: 11174299.

8. Lewis B. How to prevent endoscopic capsule retention. Endoscopy. 2005; 37:852–856. PMID: 16116537.

9. Rondonotti E, Pennazio M, Toth E, et al. Small-bowel neoplasms in patients undergoing video capsule endoscopy: a multicenter European study. Endoscopy. 2008; 40:488–495. PMID: 18464193.

10. Van Weyenberg SJ, Van Turenhout ST, Bouma G, et al. Double-balloon endoscopy as the primary method for small-bowel video capsule endoscope retrieval. Gastrointest Endosc. 2010; 71:535–541. PMID: 20189512.