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Case Reports in Surgery
Volume 2019, Article ID 1016534, 10 pages
https://doi.org/10.1155/2019/1016534
Case Report

Unusual Presentation of a Sigmoid Mass with Chicken Bone Impaction in the Setting of Metastatic Lung Cancer

1School of Medicine, University of Exeter, Exeter, Devon, UK
2School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
3Department of Medical Oncology, The Prince Charles Hospital, Brisbane, Queensland, Australia
4Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
5Department of Pathology, The Prince Charles Hospital, Brisbane, Queensland, Australia

Correspondence should be addressed to Manju Dashini Chandrasegaram; moc.oohay@inihsadujnam

Received 27 March 2019; Accepted 20 June 2019; Published 26 June 2019

Academic Editor: Tahsin Colak

Copyright © 2019 Ziad Zeidan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Ingestion of foreign bodies can cause various gastrointestinal tract complications including abscess formation, bowel obstruction, fistulae, haemorrhage, and perforation. While these foreign body-related complications can occur in normal bowel, diseased bowel from inflammation, strictures, or malignancy can cause diagnostic difficulties. Endoscopy is useful in visualising the bowel from within, providing views of the mucosa and malignancies arising from here, but its ability in diagnosing extramural malignancies arising beyond or external to the mucosa of the bowel as in the case of metastatic extramural disease can be limited. Case Summary. We present the case of a 60-year-old female with an impacted chicken bone in the sigmoid colon with formation of a sigmoid mass, on a background of metastatic lung cancer. On initial diagnosis of her lung cancer, there was mild Positron Emission Tomography (PET) avidity in the sigmoid colon which had been evaluated earlier in the year with a colonoscopy with findings of diverticular disease. Subsequent computed tomography (CT) scans demonstrated thickening of the sigmoid colon with a structure consistent with a foreign body distal to this colonic thickening. A repeat PET scan revealed an intensely fluorodeoxyglucose (FDG) avid mass in the sigmoid colon which was thought to be inflammatory. She was admitted for a flexible sigmoidoscopy and removal of the foreign body which was an impacted chicken bone. She had a fall and suffered a fractured hip. During her admission for her hip fracture, she had an exacerbation of her abdominal pain. She developed a large bowel obstruction, requiring laparotomy and Hartmann’s procedure to resect the sigmoid mass. Histopathology confirmed metastatic lung cancer to the sigmoid colon. Conclusion. This unusual presentation highlights the challenges of diagnosing ingested foreign bodies in patients with metastatic disease.