P1963 - From Lung to Intestine: A Case of Paraneoplastic Chronic Intestinal Pseudo-Obstruction Secondary to Squamous Cell Lung Cancer

Saqr Alsakarneh, MD¹, Fouad Jaber, MD¹, Anika Mittal, BA², Muhammad Shah Miran, MD¹, Mohammad Abuassi, MD³, Mir Zulqarnain, DO¹, Jennifer Von Ende, MD¹, Rasheed Musa, MD⁴, Hassan Ghoz, MD^1
1University of Missouri-Kansas City, Kansas City, MO; ²University of Missouri Kansas City School of Medicine, Kansas City, MO; ³University of Central Florida College of Medicine, Gainesville, FL; ⁴East Tennessee State University, Johnson City, TN

Introduction: Paraneoplastic Chronic Intestinal Pseudo-Obstruction (CIPO) is a rare morbid syndrome characterized by impaired gastrointestinal motility with signs and symptoms of mechanical bowel obstruction. Here we describe a case of a 62-year-old male with paraneoplastic CIPO in a setting of squamous cell lung cancer.

Case Description/Methods: A 62-year-old male with a history of squamous cell lung cancer actively undergoing radiotherapy presented to the emergency department with a 3-day history of diffuse colicky abdominal pain and constipation. He was hemodynamically stable with tachycardia at 120. On exam, he had a mildly tender and distended abdomen, with sluggish bowel sounds. Initial labs, including basic metabolic panel (BMP), were within normal limits. CT abdomen showed moderate diffuse colonic distention. Rectal enema failed to improve symptoms, and patient management of bowel obstruction was started with nothing by mouth (NPO) protocol, nasogastric tube, and intravenous fluids.
Abdominal x-ray the next day demonstrated worsening gaseous distention of the colon, with the transverse colon measuring 11 cm and the sigmoid colon up to 12.8 cm. Colonoscopy decompression confirmed diffuse colonic distention without a discrete transition point. Later, the patient’s condition worsened, requiring a repeat sigmoidoscopy for decompression with rectal tube insertion, which initially helped. Medical therapy was trialed, including a maximum laxatives regimen, two rounds of methylnaltrexone injections, and one trial of neostigmine. While therapy was tolerated, it did not improve the patient’s condition. Serial abdominal x-ray and CT scan with contrast continued to show dilated colon without mechanical obstruction. Serum anti-Hu antibodies results were positive. Collectively, the laboratory and pathologic findings were consistent with paraneoplastic CIPO

With failed medical therapies, surgical treatment was pursued, and the patient underwent a transverse loop colostomy. After surgery, abdominal distention improved, and the patient passed flatus and eventually stool via the colostomy. The patient was then discharged after the resolution of symptoms and has remained stable since.

Discussion: Patients with a history of malignancy presenting with CIPO should be further evaluated for paraneoplastic syndromes. Moreover, paraneoplastic CIPO should be considered even in those without known malignancy, as it can lead to the identification of undiagnosed tumors.



Disclosures:


Saqr Alsakarneh, MD¹, Fouad Jaber, MD¹, Anika Mittal, BA², Muhammad Shah Miran, MD¹, Mohammad Abuassi, MD³, Mir Zulqarnain, DO¹, Jennifer Von Ende, MD¹, Rasheed Musa, MD⁴, Hassan Ghoz, MD¹. P1963 - From Lung to Intestine: A Case of Paraneoplastic Chronic Intestinal Pseudo-Obstruction Secondary to Squamous Cell Lung Cancer, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.