CT of small-bowel neoplasms

Small bowel obstruction caused by secondary jejunal tumor from renal cell carcinoma: A case report

BACKGROUND

Secondary jejunal tumor from renal cell carcinoma (RCC) is extremely rare in clinical practice and is easily missed and misdiagnosed because of the low incidence and atypical symptoms.

CASE SUMMARY

A 38-year-old male patient was diagnosed pathologically with left RCC after radical nephrectomy in 2012. The patient then suffered multiple lung metastases 2 years later and was treated with oral sorafenib without progression for 6 years. In 2020, an emergency intestinal segmental resection due to intestinal obstruction was required, and postoperative pathology confirmed a jejunal secondary tumor from RCC. The patient had a smooth recovery following surgery. Three months after surgery, the patient was diagnosed with left adrenal metastasis, and subsequent sintilimab therapy has stabilized his condition.

CONCLUSION

This report is written to remind urologists and pathologists of the potential for small intestinal secondary tumors when a patient with a history of RCC seeks treatment for digestive symptoms. Enteroscopy and abdominal contrast-enhanced computed tomography are essential means of examination, but severe cases require immediate surgical intervention despite the lack of a preoperative examination to distinguish tumor attributes.

Occult Adenocarcinoma Arising in Crohn’s-Related Strictures: A Case Series

Strictures are frequent complications of Crohn’s disease, but malignant small bowel strictures are uncommon and their diagnosis is often challenging. In this case series, we present 3 patients with underlying Crohn’s disease and symptomatic strictures who were found to have adenocarcinomas arising within the strictures at time of operation or after histopathological examination. Given the critical need to identify such malignancies early and the diagnostic difficulty, we use this opportunity to review the presentation, diagnosis, and management of strictures and adenocarcinomas arising in the ileum to raise awareness of this entity so that optimal outcomes can be achieved, if identified early in the disease course.

Cross-Sectional Imaging of Small Bowel Malignancies

Small bowel malignancies are rare neoplasms, usually inaccessible to conventional endoscopy but detectable in many cases by cross-sectional imaging. Modern multidetector computed tomographies permit accurate diagnosis, complete pretreatment staging, and follow-up of these lesions. In this review, we describe the cross-sectional imaging features of the most frequent histologic subtypes of the small bowel malignancies.

Intestinal obstruction role of CT

CT has significantly advanced the evaluation of small and large bowel obstruction, especially in the acute situation where high-grade or possibly strangulating obstruction is being encountered. Any physician involved in evaluating patients with bowel distention and abdominal pain where obstruction becomes a distinct diagnostic possibility should be aware of the attributes and limitations of this modality to provide the best patient care. New technological advances will hopefully limit radiation exposure and provide even more definitive information in the diagnosis of bowel obstruction.

Adenocarcinoma of the small bowel

Cancer of the small bowel is a rare entity but its incidence is rising. Historically, outcome is poor despite apparent curative resection. At present surgery remains the only treatment modality of proven benefit in the management of this disease. Recent data would suggest 5-year survival rates in the order of 40-50% at all sites of small bowel cancer. To improve upon this, earlier diagnosis with a high index of suspicion and multicentre adjuvant therapy trials are required.

CT and bowel disease

CT has now come of age in the detection and demonstration of bowel pathology and is likely to supplant traditional imaging techniques further in the future. Its role here has been greatly aided by the advent of fast spiral CT sequences and, with the development of even faster multidetector CT systems, this can only increase.