Patient with primary jejunal cancer

Abstract

Primary jejunal cancer is a rare disease. In this study, we report a patient in whom primary jejunal cancer was definitively diagnosed by computed tomography (CT) and enteroscopy prior to surgery.
A 50-year-old woman presented chiefly complaining of vomiting and nausea, and her condition was diagnosed at another clinic as gastroenteritis. As there was no improvement in her symptoms, she was referred by the clinic to our hospital. Esophagogastroduodenoscopy did not show any significant findings. Her condition improved when she fasted, but she experienced abdominal symptoms of nausea and vomiting upon starting oral intake. Abdominal contrast enhanced CT confirmed a tumor in the proximal jejunum beyond the Treitz ligament, and dilatation of the oral gastrointestinal tract. Oral enteroscopy was performed, and an annular stenosis-type tumor was confirmed at the proximal jejunum, in approximately the same location as on the CT image. We were unable to pass an enteroscope due to severe stenosis caused by the tumor. The histopathological features of a biopsy specimen from the tumor indicated tubular adenocarcinoma. Therefore, partial resection of the duodenum and jejunum, and dissection of the regional lymph node were performed. Primary jejunal cancer does not exhibit uniquely defining symptoms, although epigastric distress, nausea and vomiting are common. Although gastroenteritis is usually treated as a common disease, if conditions do not improve CT is indicated. If a disease of the small intestine is suspected it is advisable to consider a small bowel series, and if possible oral enteroscopy (capsule endoscopy, double or single balloon endoscopy) and a PET-CT.