E0672 - Duodenal Obstruction Secondary to Metastatic Urothelial Carcinoma: A Novel Presentation of a Common Malignancy

Zahra Dossaji, DO¹, Kyaw Min Tun, DO¹, Jose Aponte-Pieras, MD¹, Muhammad Farooqui, MD², Gordon Ohning, MD, PhD^1
1Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV; ²American College of Gastroenterology, Las Vegas, NV

Introduction: Urothelial carcinoma, also known as transitional cell carcinoma (TCC), is the most common urological malignancy. It commonly spreads to the pelvic lymph nodes, lung, bone and liver and rarely metastasizes to the gastrointestinal tract. Only a few cases of duodenal obstruction secondary to metastatic TCC have been reported to date. Herein we report a case of a patient with a recently diagnosed right renal mass presenting with intractable nausea and vomiting secondary to duodenal obstruction from local metastasis of TCC.

Case Description/Methods: An 80-year female diagnosed with right renal mass on CT scan 2 months prior presented with nausea, vomiting, diarrhea and 15-pound weight loss. CT of the abdomen without contrast revealed an ill-defined renal mass with extension into the perinephric soft tissues and multiple low-attenuation lesions in the liver concerning for metastasis. The visualized portion of the small bowel on the CT was unremarkable. A liver biopsy of the mass revealed metastatic TCC with immunohistochemical stains positive for CK 7, CK 20 and GATA-3 . Gastroenterology team was consulted for intractable nausea and vomiting. An upper endoscopy revealed duodenopathy with friable tissue and mottling in the second portion of the duodenum. A severe luminal stenosis prevented further endoscope advancement. Duodenal mucosa biopsies revealed findings consistent with TCC. Plans for palliative duodenal stent insertion to relieve the symptoms of the obstruction were deferred due acute clinical decline; the patient was transitioned to hospice care.

Discussion: Duodenal and rectal obstructions from urological malignancies are relatively uncommon and only a few cases of symptomatic metastatic TCC to the duodenum have been reported in literature. Malignant obstructions are not always identified on imaging and can be difficult to diagnose unless patients are symptomatic. In our case, persistent nausea and vomiting was attributed to generalized malaise from her known malignancy, and duodenal obstruction was only identified following endoscopy. Duodenal obstructions due to malignancies are generally treated with either surgical bypassing, colostomy, or endoluminal stent placement. However, these interventions are only palliative, and the diagnosis confers a poor prognosis. We aim to provide further knowledge and clinical experience regarding duodenal obstruction secondary to TCC for early identification and management.


Disclosures:


Zahra Dossaji, DO¹, Kyaw Min Tun, DO¹, Jose Aponte-Pieras, MD¹, Muhammad Farooqui, MD², Gordon Ohning, MD, PhD¹. E0672 - Duodenal Obstruction Secondary to Metastatic Urothelial Carcinoma: A Novel Presentation of a Common Malignancy, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.