Surgical management of small bowel metastasis from esophageal squamous cell carcinoma: a case report and literature review

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Background Small bowel metastasis from esophageal squamous cell carcinoma (ESCC) is an exceedingly rare event, typically diagnosed only during emergency surgery for obstruction or perforation. The underlying metastatic mechanisms and optimal management strategies remain poorly defined. Case presentation A 54-year-old woman with stage IVB ESCC (cT3N3M1; left supraclavicular lymph node metastasis) developed recurrent complete intestinal obstruction while receiving systemic chemo-immunotherapy and local radiotherapy. Emergency laparotomy revealed multiple serosal small bowel metastases causing segmental stenosis. Approximately 20 cm of jejunum was resected with primary side-to-side anastomosis, and a decompressive tube jejunostomy was placed. The postoperative course was uneventful, and the obstruction resolved. However, due to a rapid decline in performance status, no further anticancer therapy could be administered, and the patient died of cachexia and electrolyte imbalance two months after surgery. Conclusions In patients with known esophageal cancer, the development of “atypical” small bowel obstruction should raise immediate suspicion for peritoneal metastasis, even when conventional imaging fails to demonstrate discrete masses. Prompt surgical exploration can achieve both definitive diagnosis and effective palliation. This case also highlights the probable lymphatic route of metastatic spread and underscores the urgent need to integrate molecular biomarkers into surveillance strategies for rare but lethal metastatic patterns.