Intestinal Pseudo-Obstruction as the Presenting Manifestation of Small-Cell Carcinoma of the Lung

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Abstract
A 58 yr old woman who had presented with intestinal pseudoobstruction died 9 mo. later from rapidly progressive neurologic symptoms and autonomic insufficiency. Her gastric emptying had been markedly delayed and trasit of markers had been slowed throughout the small bowel. A 5-h manometric recording of the antrum and duodenum had shown absence of the normal interdigestive motor complex, which was replaced by irregular contractile activity of reduced amplitude. A small cell carcinoma of the lung was found at autopsy. Pathologic study of the gut showed widespread degeneration of the myenteric plexus, which was infiltrated by plasma cells and lymphocytes and contained significantly reduced numbers of neurons. The extra-intestinal nervous system had neuronal loss and lymphocytic infiltrates in dorsal root ganglia. A gastrointestinal neuropathy causing intestinal pseudoobstruction may be the presenting manifestation of a paraneoplastic syndrome associated with small-cell carcinoma.

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