Abstract
The patient was a 62-year-old man who had been diagnosed as having ankylosing spondylitis and been controlled well by prednisolone (10mg/day) from November 2006. He was urgently admitted to the hospital because of severe anemia in March 2007. Upper gastrointestinal endoscopy showed a tumor with ulceration beyond the Treitz's ligament. Abdominal enhanced CT scan showed an irregular wall thickening and the density of the tumor with heterogeneous enhancement effect. Emergency operation was performed under a diagnosis of a bleeding tumor of the jejunum. On intraoperative findings, the tumor, developed extramurally on the mesentery side with an abscess formation, was found at the jejunum about 10cm distal from the Treitz's ligament. We performed partial resection of the duodenum and jejunum including the tumor with regional lymph node dissection followed by reconstruction with side to side duodeno-jejunostomy (Over lap method). The histological diagnosis was primary jejunal adenocarcinoma with lymph node metastasis. His postoperative course was good and he could be taken off prednisolone. He has been doing well without signs of recurrence, and having no prednisolone as of 2 years after the surgery.
