A Rare Case of Colorectal Cancer With Delayed Duodenal Metastasis: A Case Report

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: The liver is the most common site of colorectal cancer (CRC) metastasis, followed by the lung, regional lymph nodes, and peritoneum. We present an exceptionally rare case of CRC metastasizing to the duodenum in a patient with a history of resolved stage IV-A ileocecal adenocarcinoma and previous liver metastasis, who had been adherent to post-surgical surveillance. Case Description/Methods: A 42-year-old woman presented with a 2-week history of persistent fatigue, shortness of breath, presyncope, and hematochezia. Her medical history was notable for stage IV-A ileocecal adenocarcinoma with liver metastasis, for which she had undergone a right hemicolectomy and partial hepatectomy, both with negative margins for dysplasia and adenocarcinoma. Subsequent surveillance, including annual carcinoembryonic antigen (CEA) levels and computed tomography (CT) scans, consistently showed no evidence of disease recurrence. However, during the current presentation, the patient exhibited a hemoglobin level of 5.9 g/dL, necessitating a transfusion of 2 units of blood. A CT scan of the abdomen and pelvis with intravenous contrast revealed a central mesenteric mass, measuring up to 3 cm in long axis dimension. This mass invaded the duodenum, encased the superior mesenteric artery, abutted the superior mesenteric vein, and displayed a new 8 mm lesion in the peripheral hepatic segment 5/8. Notably, CEA levels were elevated at 11.1 ng/mL, down from 13.1 ng/mL a year prior. An esophagogastroduodenoscopy revealed a 3 cm fungating mass in the second part of the duodenum, raising concerns for carcinoma. Biopsies confirmed the presence of invasive adenocarcinoma originating from the colon and metastasizing to the duodenum. Subsequent colonoscopy identified diverticulosis, non bleeding hemorrhoids, and ulcers in the colon. The case was presented to the tumor board, which collectively determined that the patient was not a candidate for surgical resection due to vascular involvement, and palliative care was consulted given the poor prognosis. Discussion: Among CRC patients, the most common cause of death is disease recurrence and metastasis. Despite adhering to current guidelines, our patient developed recurrent metastatic disease in both the colon and duodenum. Further evaluation and possible modification in the guidelines for perioperative surveillance of high-risk patients can help to anticipate disease recurrence and improve health outcomes, particularly as it relates to less common CRC metastatic sites.

Volume

119

Issue

10

First Page

S2146

Last Page

S2147

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