Invasive gastric carcinoma with metastasis to the small intestine and colon simulating stenosing Crohn disease
case report
DOI:
https://doi.org/10.47456/rbps.v26i1.51183Keywords:
Crohn Disease, Stomach Neoplasms, Neoplasm MetastasisAbstract
Introduction: Signet ring cell gastric cancer is an aggressive neoplasm, with rare metastases to the intestines. However, when it occurs, it can cause intestinal subocclusion syndrome, although it can generate nonspecific symptoms, which makes diagnosis difficult. Objectives: Report a rare case of gastric cancer with metastases to the small intestine and colon, simulating Crohn's disease, thus helping physicians to broaden their vision for differential diagnoses when faced with similar cases. Methods: Data collection from the patient's medical records. Case presentation: Woman, 71 years old, with recurrent intestinal subocclusion and unintentional weight loss, with severe impairment of nutritional status. Colonoscopy showed an insurmountable stenosing lesion in the right colon, in addition to abdominal tomography showing stenosis of small bowel loops with upstream dilatation and colonic stenosis associated with signs suggestive of a local inflammatory process. Upper digestive endoscopy showed ulceroinfiltrative lesion in the gastric antrum with histopathology indicative of invasive signet ring cell gastric carcinoma. The patient was not clinically fit for curative chemotherapy or surgical treatment, and an attempt at strictureplasty and/or enterectomy was chosen to improve the quality of life. However, exploratory laparotomy revealed intestinal metastases secondary to gastric neoplasia, and the diagnosis of Crohn's disease was ruled out. Conclusion: Despite being a rare presentation, intestinal metastasis from gastric cancer can occur and simulate other conditions, such as Crohn's disease, becoming a diagnostic challenge, especially when it affects loops of the small intestine.
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