A case of metastatic squamous cell carcinoma of the hypopharynx manifesting as acute abdomen.

Introduction: Squamous cell head and neck cancers are usually confined to local and regional sites but occasionally, patients may present with rare manifestations of distant metastases.

Clinical Picture: A 23-year-old female was treated with concurrent chemo-radiotherapy for stage IVA post-cricoid squamous cell carcinoma. A month later, she presented with acute abdomen and was found to have extensive peritoneal nodules at laparotomy. Intestinal obstruction soon followed.

Treatment: She was managed conservatively for the intestinal obstruction and given weekly paclitaxel.

Outcome: She continued to deteriorate and succumbed shortly after the diagnosis of carcinomatosis peritoneii.

Conclusion: This rare and aggressive presentation reminds us to be cognizant of relapsed head and neck cancers manifesting atypically, and the need for more aggressive search of distant disease in at least some subgroups of head and neck cancer.