A Case of Primary Small Bowel Cancer Presented with Intestinal Obstruction 9 Years after Gastrectomy

Abstract

Small bowel cancer is rare and accounts for only 0.3 - 4.9 % of all digestive tract malignancies. We herein report a case of upper jejunal carcinoma presented with intestinal obstruction 9 years after gastrectomy. A 58-year-old woman complaining of epigastralgia and vomiting was referred to our hospital with a diagnosis of intestinal obstruction. Computed tomography revealed thickening of the jejunal wall and dilatation of its oral side including the stomach and duodenum. A nasal gastric tube was placed for decompression. An esophagogastroduodenoscopy revealed a tumor encircling the entire circumference of the upper jejunum and the biopsied result was well differentiated adenocarcinoma. We diagnosed the case as primary small bowel cancer and performed partial jejunum resection including lymph node dissection up to the trunk of superior mesenteric artery. The postoperative course was uneventful and she was discharged on 11th postoperative day. Pathological findings showed pT4a (SE), Ly1a (SM), V1b (SS EVG), BD1, pN1a, Pn1b, p stage IIIA by the UICC classification. Small bowel cancer after gastrectomy is extremely rare and the prognosis is not so good. Therefore, earlier diagnosis and induction of treatment are currently favorable. Recent investigations suggest an increase in the risk of small bowel carcinogenesis in post-gastrectomy patients. Thus, in practice of small bowel obstruction after gastrectomy, we should perform upper gastrointestinal series and endoscopy keeping a possible primary cancer in mind.