A case of perforated primary small intestinal cancer

Abstract

A 42-year-old man had abdominal pain after lunch. He presented in our hospital with abdominal pain, tenderness and peritoneal sign. Computed tomography (CT) showed free air in abdominal cavity. An emergency surgery was performed under a diagnosis of gastrointestinal perforation.
We found a goose-egg-sized hard ileal tumor located about 100 cm on the oral side from the ileocecal valve, and the perforation occurred at its center. In addition, enlarged lymph nodes were found in the mesentery around the tumor.
We made a diagnosis as perforation of an ileal malignant tumor and generalized peritonitis. The partial resection of the ileum with lymph node dissection and abdominal cavity drainage procedure was performed.
The resected specimen revealed an ulcerating tumor and a perforated portion at the bottom of the deep ulcer. Histological diagnosis was moderately differentiated tubular adenocarcinoma. The symptoms of ileus, such as abdominal distention and nausea, are frequent initial symptoms of primary small intestinal cancer but generalized peritonitis is a very rare initial symptom. We report this case with a review of previously reported cases in the literature.