Because of its very low incidence and lack of specific symptoms, carcinoma of the small intestine is seldom diagnosed preoperatively.
Ten months prior to admission, a forty four years old male began passing tarry stool. Colonoscopy at the other hospital disclosed only a diverticulosis in the ascending colon. He continued to deteriorate with several more episodes of melena. At the time of admission, hemoglobin was 8.9gm/dl and tarry stool was still present. Endoscopic examinations of the upper and lower GI tracts failed to identify bleeding source. CT, angiogram of SMA, and barium swallow were noncontributory. Small bowel follow through via long intestinal tube, however visualized an annular constricting lesion at 60cm from the ligament of Treitz. Presence of this lesion was confirmed by fibroptic jejunoscopy as an annular constricting type lesion. Biopsy yielded well differentiated adenocarcinoma. Partial resection of the small intestine with regional lymphadenectomy was performed. This case suggested feasibility of fibroptic jejunoscopy for making a definite diagnosis of carcinoma of the small intestine.
