A rare cause of melena in lung cancer

A 67-year-old woman was admitted to our department for one-month duration of asthenia. She was previously operated of upper right lobectomy for a high-grade sarcomatoid carcinoma. The patient was hemodynamically stable. Hemoglobin was 5.4 g/dL, and she was transfused with three blood units. An upper gastrointestinal endoscopy was carried out and it was unremarkable; a colonoscopy was then performed and a voluminous ulcerated polyp with a large base of implantation of the proximal descending colon was seen and removed without complications ( Fig. 1a). The pathological examination of the polyp was compatible with a metastasis of the lung cancer ( Fig. 1b). Because the appearance of melena requiring further hemotrasfusions, the patient underwent capsule endoscopy that showed a bleeding spontaneously large ulceration of the jejunum ( Fig. 2). She was operated and 9 cm of jejunum were resected ( Fig. 2); after surgical exploration another segment of ileum of 12 cm was resected ( Fig. 2). The pathological examination of the surgical specimens demonstrated metastases of the lung cancer ( Fig. 2).