Projectile vomiting as presentation of duodenal intramural metastasis from cervical cancer

Yu-Hsiang Lin; Chih-Yi Hsu; Shin-E Wang; Kung-Yi Sung; Chun-Yu Liu

doi:10.1016/j.tjog.2021.10.011

Projectile vomiting as presentation of duodenal intramural metastasis from cervical cancer

Taiwan J Obstet Gynecol. 2022 Nov;61(6):1053-1057. doi: 10.1016/j.tjog.2021.10.011.

Authors

Yu-Hsiang Lin¹, Chih-Yi Hsu², Shin-E Wang³, Kung-Yi Sung⁴, Chun-Yu Liu⁵

Affiliations

¹ School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong Street, Taipei 112, Taiwan; Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
² School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong Street, Taipei 112, Taiwan; Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
³ School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong Street, Taipei 112, Taiwan; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong Street, Taipei 112, Taiwan; Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan. Electronic address: cyliu3@vghtpe.gov.tw.

PMID: 36427973
DOI: 10.1016/j.tjog.2021.10.011

Abstract

Objective: To report a case and review literature of bowel metastases from cervical squamous cell carcinoma.

Case report: A 49-year-old woman with a history of FIGO 2013 stage IVB cervical squamous cell carcinoma presented with refractory nausea, projectile vomiting, anorexia, postprandial abdominal pain, and significant weight loss for six months. Restaging images didn't reveal viable tumors but thickened duodenal wall indicating gastric outlet obstruction. Initially, the etiology was masked by chronic erosive duodenitis and mistreated as a duodenal ulcer. After repeated gastrointestinal endoscopic biopsy confirming intramural duodenal metastasis from cervical squamous cell carcinoma, the patient was treated successfully by gastrojejunostomy and adjuvant chemotherapy. She has remained asymptomatic and disease-free for more than 12 months since the surgical metastasectomy.

Conclusion: Intestine metastasis from cervical cancer is a rare cause that may present as projectile vomiting due to gastric outlet obstruction. Prompt recognition and surgical intervention may provide good outcomes despite the metastatic nature.

Keywords: Duodenum; Gastric outlet obstruction; Uterine cervical neoplasm; Vomiting.

Publication types

Case Reports

MeSH terms

Carcinoma, Squamous Cell* / complications
Carcinoma, Squamous Cell* / therapy
Female
Gastric Outlet Obstruction* / etiology
Gastric Outlet Obstruction* / surgery
Humans
Middle Aged
Stomach Diseases* / complications
Uterine Cervical Neoplasms* / complications
Uterine Cervical Neoplasms* / therapy
Vomiting / etiology