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BMJ Case Rep ; 14(1)2021 Jan 26.
Article de Anglais | MEDLINE | ID: mdl-33500301

RÉSUMÉ

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.


Sujet(s)
Carcinome épidermoïde/complications , Constipation/étiologie , Gastroparésie/étiologie , Tumeurs du poumon/complications , Syndromes neurologiques paranéoplasiques/étiologie , Sujet âgé , Antiémétiques/usage thérapeutique , Carcinome épidermoïde/imagerie diagnostique , Constipation/diagnostic , Constipation/traitement médicamenteux , Constipation/physiopathologie , Agents gastro-intestinaux/usage thérapeutique , Maladies gastro-intestinales/diagnostic , Maladies gastro-intestinales/traitement médicamenteux , Maladies gastro-intestinales/étiologie , Maladies gastro-intestinales/physiopathologie , Motilité gastrointestinale , Gastroparésie/diagnostic , Gastroparésie/traitement médicamenteux , Gastroparésie/physiopathologie , Glycérol/usage thérapeutique , Humains , Lactulose/usage thérapeutique , Tumeurs du poumon/imagerie diagnostique , Mâle , Métoclopramide/analogues et dérivés , Métoclopramide/usage thérapeutique , Morphine/effets indésirables , Constipation induite par les opioïdes/diagnostic , Soins palliatifs , Syndromes neurologiques paranéoplasiques/diagnostic , Syndromes neurologiques paranéoplasiques/physiopathologie , Tramadol/effets indésirables
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