IJCM  Vol.4 No.6 , June 2013
Primary Small Bowel Tumour Presenting as Bowel Obstruction in a Patient with a Virgin Abdomen
ABSTRACT

Primary malignancies of the small bowel are rare and usually present with vague, non-specific symptoms. This leads to diagnostic difficulties for both physician and radiologists alike. We present a case of a 54-year-old lady with a virgin abdomen who initially presented to hospital with vague abdominal symptoms suggestive of gastroenteritis. She responded partially to conservative treatment but represented to hospital 3 weeks later with obstructive symptoms. Contrast CT was inconclusive with regards to diagnosis. A diagnostic laparoscopy was performed, revealing an infiltrative growth. Consequently, she underwent segmental laparoscopic-assisted small bowel resection and recovered well post-operatively. After further histological and endoscopic investigations, a final diagnosis of primary small bowel adenocarcinoma was given. As the prognosis of small bowel malignancy is stage-dependent, this case demonstrates a high index of suspicion is necessary to reach early diagnosis, especially for symptoms non-responsive to conventional treatment. Diagnostic laparoscopy should be considered early as a definitive diagnostic tool.


Cite this paper
X. Wu, H. Cheung, C. Chung and M. Li, "Primary Small Bowel Tumour Presenting as Bowel Obstruction in a Patient with a Virgin Abdomen," International Journal of Clinical Medicine, Vol. 4 No. 6, 2013, pp. 287-290. doi: 10.4236/ijcm.2013.46050.
References
[1]   S. F. Altekruse, C. L. Kosary, M. Krapcho, N. Neyman, R. Aminou, W. Waldron, J. Ruhl, N. Howlader, Z. Tatalovich, H. Cho, A. Mariotto, M. P. Eisner, D. R. Lewis, K. Cronin, H. S. Chen, E. J. Feuer, D. G. Stinchcomb and B. K. Edwards, Eds., “SEER Cancer Statistics Review, 19752007,” National Cancer Institute, Bethesda, 2010. http://seer.cancer.gov/csr/1975_2007/

[2]   J. R. Howe, L. H. Karnell, H. R. Menck and C. ScottConner, “Adenocarcinoma of the Small Bowel Review of the National Cancer Data Base, 1985-1995,” Cancer, Vol. 86, No. 12, 1999, pp. 2693-2706. doi:10.1002/(SICI)1097-0142(19991215)86:12<2693::AID-CNCR14>3.0.CO;2-U

[3]   K. Y. Bilimoria, D. J. Bentrem, J. D. Wayne, C. Y. Ko, C. L. Bennett and M. S. Talamonti, “Small Bowel Cancer in the United States: Changes in Epidemiology, Treatment, and Survival Over the Last 20 Years,” Annals of Surgery, Vol. 249, No. 1, 2009, pp. 63-71. doi:10.1097/SLA.0b013e31818e4641

[4]   R. M. Zollinger Jr., “Primary Neoplasms of the Small Intestine,” American Journal of Surgery, Vol. 151, No. 6, 1986, pp. 654-658. doi:10.1016/0002-9610(86)90035-8

[5]   D. D. T. Maglinte, K. O’Connor, J. Bessette, S. M. Chernish and F. M. Kelvin, “The Role of the Physician in the Late Diagnosis of Primary Malignant Tumors of the Small Intestine,” American Journal of Gastroenterology, Vol. 86, No. 3, 1991, pp. 304-306.

[6]   A. J. Minardi Jr., G. B. Zibari, D. F. Aultman, R. W. McMillan and J. C. McDonald, “Small-Bowel Tumors,” Journal of the American College of Surgeons, Vol. 186, No. 6, 1998, pp. 664-668. doi:10.1016/S1072-7515(98)00092-1

[7]   B. S. Dabaja, D. Suki, B. Pro, M. Bonnen and J. Ajani, “Adenocarcinoma of the Small Bowel: Presentation, Prognostic Factors and Outcome of 217 Patients,” Cancer, Vol. 101, No. 3, 2004, pp. 518-526. doi:10.1002/cncr.20404

[8]   N. M. Lee and G. M. Eisen, “10 Years of Capsule Endoscopy: An Update,” Expert Review of Gastroenterology and Hepatology, Vol. 4, No. 4, 2010, pp. 503-512. doi:10.1586/egh.10.44

[9]   R. M. Gore, U. K. Mehta, J. W. Berlin, V. Rao and G. M. Newmark, “Diagnosis and Staging of Small Bowel Tumours,” Cancer Imaging, Vol. 6, No. 1, 2006, pp. 209212. doi:10.1102/1470-7330.2006.0031

[10]   R. R. Hutchins, A. Bani Hani, P. Kojodjojo, R. Ho and S. J. Snooks, “Adenocarcinoma of the Small Bowel,” ANZ Journal of Surgery, Vol. 71, No. 7, 2001, pp. 428-437. doi:10.1046/j.1440-1622.2001.02149.x

 
 
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