Metastatic lung cancer causing recurrent small-bowel intussusception

What happened, in summary

A 55-year-old woman with active non-small cell lung cancer presented with 3 days of colicky abdominal pain, worsening nausea, vomiting and abdominal distension. She was already receiving chemotherapy. Her lung tumour carried an EGFR mutation, while an adrenal metastasis was only considered likely and is not treated as a confirmed metastatic site here.

CT showed duodenojejunal intussusception. Initial treatment with nasogastric drainage, fluids and total parenteral nutrition led to temporary improvement, but the obstruction repeatedly returned. On hospital day 14, she underwent laparotomy. Surgeons found a very proximal jejunojejunal intussusception, reduced it and resected the involved bowel segment, creating a double-barrel jejunostomy.

Pathology found multiple malignant polyps in the resected jejunum. The lesions were positive for markers supporting lung origin and showed both adenocarcinoma and high-grade neuroendocrine carcinoma. Genetic analysis identified an EGFR exon 19 deletion. The small-bowel lesions confirmed distant metastatic lung cancer, establishing Stage IV disease.

Her postoperative recovery was steady and satisfactory. After multidisciplinary review, further management shifted to palliation. Fluid and nutritional needs were optimized, stoma output was managed and long-term parenteral nutrition was planned.