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Case report
Gastrointestinal dysmotility in a patient with advanced lung cancer: paraneoplastic or drug-induced?
  1. Raphael Figuiredo Dias1,
  2. Mirella Monique Lana Diniz1,
  3. Bruno Campos Santos1 and
  4. Vandack Alencar Nobre2
  1. 1Universidade Federal de Minas Gerais Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brazil
  2. 2Clínica Médica, Universidade Federal de Minas Gerais Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brazil
  1. Correspondence to Dr Bruno Campos Santos; bruno_campos{at}outlook.com

Abstract

A 75-year-old man was hospitalised for bronchoscopy with biopsy due to a suspicious pulmonary mass at chest tomography. He had significant dyspnoea, constipation, nausea, vomiting, anorexia and a 33% loss of weight in the past 3 months. Biopsy revealed a pulmonary squamous cell carcinoma, which was inoperable. Tramadol used at home for 3 months was replaced by morphine on admission. The patient remained constipated despite prokinetics and laxatives, leading to the diagnostic hypothesis of paraneoplastic motility disorder and opioid-induced constipation. Abdominal tomography ruled out the possibility of mechanical obstruction. As complications, the patient presented superior vena cava syndrome and opioid (morphine) intoxication. The patient died a few days later. The management of this case highlights the importance of multidisciplinary care and the challenges of palliative oncology care. Paraneoplastic motility disorder must always be considered among the mechanisms of intestinal dysfunction in patients with advanced oncological disease.

  • Gastrointestinal system
  • Lung cancer (oncology)
  • End of life decisions (palliative care)
  • Pain (palliative care)

https://doi.org/10.1136/bcr-2020-237835

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    Footnotes

    • Contributors RFD conceptualised and designed the paper, acquired data and drafted the article. MMLD conceptualised and designed the paper, acquired data and drafted the article. BCS designed the paper and revised it critically for important intellectual content. VAN designed the paper and revised it critically for important intellectual content. All authors agree to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Next of kin consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.