[Primary small bowel adenocarcinoma]

Bile duct metastasis of duodenal bulb carcinoma misdiagnosed as postoperative cholangitis: A case report

Duodenal bulb carcinoma is very rare, and its metastasis to the bile duct is even extremely rare. As a result, both tend to be misdiagnosed or have a missed diagnosis. Here we report a case of bile duct metastasis of duodenal bulb carcinoma after surgery, which was initially misdiagnosed as cholangitis. A definite diagnosis was made by postoperative pathology after biliary intestinal anastomosis. Our case suggests that clinicians should enhance their awareness of duodenal adenocarcinoma and its metastasis to the bile duct to reduce or avoid missed diagnosis and misdiagnosis and improve patients' survival rate.

Primary adenocarcinoma of the small intestine presenting as superior mesenteric artery syndrome: A case report

Superior mesenteric artery syndrome (SMAS) is an uncommon cause of vomiting and weight loss due to compression of the third part of the duodenum by the superior mesenteric artery. Small bowel adenocarcinoma is an uncommon tumor, which is frequently delayed in diagnosis as its symptoms and signs are non-specific. The present study describes a case of SMAS occurring in a 51-year-old man, caused by intestinal obstruction secondary to a primary adenocarcinoma of the duodenal-jejunal junction. To the best of our knowledge, the present case is the first report of small bowel adenocarcinoma masquerading as SMAS. The present case highlights the importance of considering the possibility of SMAS in patients with upper bowel obstruction caused by intestinal carcinoma.

[Primary adenocarcinoma of the terminal ileum, synchronous]

BACKGROUND

Among the rarest types of cancer found are the small intestine malignancies, representing only 2% of all gastrointestinal cancer and 0.1-0.3% of all malignancies. The most common subtype of this tumour is the adenocarcinoma, which is located mainly in the duodenum, jejunum and, rarely, in ileum.

CLINICAL CASE

A 75 year-old male, with no any surgical history, who in the previous three months, referred to two clinical episodes of partial bowel obstruction and unquantified weight loss. When admitted into the surgical service, the patient referred to a partial bowel obstruction of more than one week onset. A laparotomy was performed, finding 3 stenosis rings at the ileum end portion, carrying out an intestinal resection and enteral-enteral anastomosis. On the seventh day there was dehiscence of the anastomosis and abdominal sepsis. New surgery was performed with the resection of the intestinal anastomosis and an ileostomy. The pathologist report indicated a small bowel adenocarcinoma moderately differentiated, ulcerated, and multifocal. It was classified as stage III or T3N1M0. The patient progress was satisfactorily, managed as outpatient with postoperative chemotherapy with 5 fluorouracil and cisplatin. The patient died a year later due to liver metastases.

CONCLUSIONS

Due to the extreme rarity of the case, is very likely that general surgeons may find one or two cases of adenocarcinoma of the ileum in their professional career. Thus, they must suspect this pathology when faced with an episode of intestinal obstruction in the adult.