The initial manifestation of lung cancer as gastrointestinal tract metastasis is an extremely rare event. In most cases, these metastases are diagnosed after the primary lung tumor, when potentially life-threatening complications develop, often requiring emergency surgery. Regardless of treatment, these patients have a poor prognosis, due to the advanced stage of their disease. We report a clinical case of a gastrointestinal fistula arising from a small bowel non-small cell lung cancer (NSCLC) metastasis as a first manifestation of the disease, in a 43-years-old man. He underwent laparatomy with segmental small bowel and colon resection, followed by pulmonary lobectomy. A few months later the patient presented a cerebellum metastasis and was submitted to metastasectomy and holocranial radiation. After that event, systemic chemotherapy was prescribed, due to bone metastasis. Twenty-nine month after diagnosis, the patient is alive with a stable general condition. Aggressive surgical treatment of both primary and metastatic tumors can provide palliation and may improve short-term survival.
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