Duodeno-colic fistula as a rare presentation of XXXX - surgical treatment of a stage IV oligometastatic @entity358 .

@entity1 @entity294 @entity391 @entity2 @entity358 @entity3 @entity395 @entity1962 @entity694
INTRODUCTION: Rare @entity1962 have no defined standard approach given their low incidence. They present with nonspecific imaging characteristics and are described as having worse prognosis than other @entity358 , with greater likelihood of local invasion and early @entity3 . PRESENTATION OF CASE: Male caucasian @entity1 , 43 years, 26 pack-year smoking history, presented with watery @entity294 , @entity391 and loss of 25% body weight (20kg) in four weeks. Colonoscopy identified a left @entity694 . Abdominal CT/ultrasound showed a large fistulous lesion between the 4th portion of the duodenum and left colon. CT showed a solid mass in the @entity358 . Endoscopy and transthoracic biopsy were inconclusive. En bloc D3 and D4 duodenectomy, proximal enterectomy and left hemicolectomy were performed, with inconclusive histology of the specimen. Three months later, a right upper lung lobectomy with lymphadenectomy was performed, revealing an @entity1962 of lung origin, R0, staged as pT2pN0pM1b. Six months later, a single dural @entity3 in the left cerebellopontine angle was detected and resected, with subsequent holocranial radiotherapy and systemic adjuvant chemotherapy. @entity1 is currently with 18 months follow-up, in good general health and with no evidence of recurrent disease. DISCUSSION: There are no specific guidelines to treat oligometastatic @entity2 . Our approach was abdominal surgery as a life-saving procedure and, months later, oncological resection of primary @entity2 and metachronous @entity3 to the brain. CONCLUSION: A systematic, @entity1 -oriented, @entity1 -shared, multidisciplinary approach is particularly relevant when dealing with atypical presentations of @entity395 in young @entity1 .
