A Case of Small Bowel Adenocarcinoma in Patient Who Had Duodenojejunostomy = A Case of Small Bowel Adenocarcinoma in Patient Who Had Duodenojejunostomy

다국어 초록 (Multilingual Abstract)

Small bowel malignancies are very rare and account for 0.1-0.3% of all malignancies, and 0.35% in South Korea. Primary adenocarcinoma is the most common subtype makes up 35.8% of all small bowel malignancies. According to Korea central cancer registry, 535 new cases of small bowel malignancies occurred for 2010. The clinical presentation and diagnosis of small bowel adenocarcinoma are usually delayed because the disease is not amenable to endoscopic examination, and especially it located distal to duodenum. Furthermore, incidence rate of such patient with anatomical changes in bowel is yet unknown. We authors report a case of patient with small bowel adenocarcinoma who had previously duodenojejunostomy. A 78-year old female was admitted to our hospital suffering from sustained nausea and vomiting for 2 months. Her medical history included duodenojejunostomy as treatment for small bowel mass 20 years ago, appendectomy, hypertension and type 2 diabetes mellitus. She took abdomen computed tomography (CT) scan 7 months prior to admission, showed fatty liver and renal cysts only. Abdomen CT scan at admission, however, indicated jejunal mass with distended proximal bowel loops and metastatic lymphadenopathies (LAPs) on mesentery. Small bowel series revealed near complete obstruction of jejunum with apple core like mass and ulceration. We couldn’t examine esophagogastroduodenoscopy (EGD) or capsule endoscopy since anatomical deterioration which noted in previous EGD, instead small bowel series was done for diagnosis. Mass was resided in proximal jejunum and metastatic LAPs were found in proximal mesentery intraoperatively. Small bowel segmental resection including jejunal mass with mesenteric lymph node dissection was done. Jejunal mass was diagnosed as moderate to poorly differentiated adenocarcinoma on pathology, and so as dissected lymph node. On postoperative 2 months, no recurrent malignancy is found in follow up abdomen CT scan. Her symptoms of nausea and vomiting also subsided and have good performance, either. Allude to this case, clinicians may take note of small bowel malignancy even with nonspecific symptoms if they persist or if patient had anatomical change in bowel.