Perforated Jejunal Adenocarcinoma in a COVID-19-Positive Patient* / Adenocarcinoma jejunal perfurado em paciente positivo para covid-19

Abstract Jejunal adenocarcinoma is a rare type of primary small bowelmalignancy. It is generally diagnosed at late stages and as a surgical finding, with abdominal pain or discomfort being the main associated symptom. Cases presenting with perforation are even rarer, especially without disseminated disease. The relationship between cancer and coronavirus disease 2019 (COVID-19) is still being studied, as well as the postsurgical evolution of COVID-19 patients and its possible causality of intestinal perforation. We present the case of a perforated jejunal adenocarcinoma in a COVID-19-positive patient, in whom the symptomatology secondary to the perforation led to an early diagnosis, treatment and adequate postsurgical evolution, despite the concomitant condition.

Resumo O adenocarcinoma jejunal é um tipo raro de malignidade primária do intestino delgado, o qual geralmente é diagnosticado em estágios tardios e como achado cirúrgico, sendo a dor ou o desconforto abdominal o principal sintoma associado. Casos que apresentam perfuração são ainda mais raros, principalmente sem doença disseminada. A relação entre câncer e a cornonavirus disease 2019 (covid-19) ainda está sendo estudada, assim como a evolução pós-cirúrgica de pacientes com covid-19 e sua possível causalidade de perfuração intestinal. Apresentamos o caso de um adenocarcinoma jejunal perfurado em um paciente positivo para covid-19, em que a sintomatologia secundária à perfuração levou a um diagnóstico precoce, tratamento e evolução pós-cirúrgica adequada, apesar da condição concomitante.

Adenocarcinoma of the Proximal Jejunum Misdiagnosed as Gastroparesis

The prevalence of small bowel cancer is relatively low. The abdominal pain that patients with small bowel cancer present as a symptom is non-specific and often interpreted as a normal finding on radiographic studies. To prevent delayed diagnosis of small bowel cancer, practitioners must maintain a certain level of suspicion. We report a case of delayed diagnosis of jejunal cancer as it was misdiagnosed as gastroparesis. A 69-year-old woman complained of recurrent nausea and vomiting. At the beginning of her hospitalization, we could not diagnose mechanical obstruction through esophagogastroduodenoscopy and abdominal computed tomography. A gastric emptying study revealed delayed gastric emptying. Although the patients received treatments, including administration of prokinetics and botulinum toxin injection, for gastroparesis, her symptoms aggravated. Subsequently, plain radiography of the abdomen revealed a double-bubble sign. Abdominal computed tomography was performed under the suspicion of small bowel obstruction; however, the diagnosis was not clear. Consequently, exploratory laparoscopy was performed. She underwent surgical management, including small bowel segmental resection and duodenojejunostomy, due to the jejunal mass with involvement of the stomach, pancreatic head, and mesentery of the transverse colon. The postoperative pathological results revealed a moderately differentiated adenocarcinoma of the jejunum.

Tumor del estroma gastrointestinal: presentación de caso / Gastrointestinal stromal tumor: case report

RESUMEN Fundamento: los tumores del estroma gastrointestinal, conocidos en inglés como gastrointestinal stromal tumors, son tumores mesenquimales que aparecen en cualquier sitio del tracto gastrointestinal. Muchos de los cuales suelen ser pediculados y de difícil diagnóstico preoperatorio. Objetivo: exponer un caso de un tumor del estroma gastrointestinal de localización poco frecuente en duodeno, más raro aún su ubicación en yeyuno. Caso clínico: paciente masculino de 77 años de edad que presenta un tumor del estroma gastrointestinal de localización en yeyuno fue atendido en el Hospital Universitario Amalia Simoni, por el servicio de urgencia en el periodo 2016-2017. Conclusiones: los tumores mesenquimales son pocos frecuentes y los del estroma gastrointestinal lo son aún más, donde la localización yeyunal los menos encontrados y en su mayoría el diagnóstico se realiza durante el acto quirúrgico.

ABSTRACT Background: the gastrointestinal stromal tumors, are mesenchymal tumors that appear in any place of gastrointestinal tract. Many of them can be pediculate and difficult pre-operatory diagnosis. Objective: to explain a case of gastrointestinal stromal tumor of difficult localization in duodenum but it is even stranger to find it in jejune. Clinical case: a 77-year-old male patient who presents a gastrointestinal stromal tumor located in jejune, he was attended in Amalia Simoni University Hospital, by the emergency services, in the period of 2016-2017. Conclusions: the mesenchymal tumors are not frequent and those of gastrointestinal stroma are even rarer but, being the localization jejunal less found and in its majority the diagnosis is made during the surgical act.

Adenocarcinoma de yeyuno: infrecuente cáncer gastrointestinal / Adenocarcinoma of jejunum: an infrequent type of intestinal cancer

Los tumores de intestino delgado son infrecuentes, generalmente se presentan con cuadros clínicos inespecíficos y la mayoría de los diagnósticos se hacen en etapas avanzadas de la enfermedad. Se presenta un paciente de sexo masculino de 58 años de edad, con dolor abdominal generalizado, intermitente, vómitos ocasionales, pérdida de peso y llenura posprandial, de dos meses de evolución. Ingresó con manifestaciones clínicas de obstrucción intestinal, y en una tomografía abdómino-pélvica se observó disminución abrupta del calibre en el yeyuno proximal. Se le practicó una laparotomía en la que se evidenció una lesión obstructiva del yeyuno que se resecó y se anastomosó el segmento. En la histopatología se reportó adenocarcinoma de yeyuno moderadamente diferenciado T3N0M0. Presentó una evolución favorable

Small bowel tumors are infrequent. Adenocarcinoma of the jejunum constitutes a rare diagnosis. It usually presents with nonspecific clinical symptoms and most patients are diagnosed in advanced stages of the disease. We present the case of a 58-year-old man with a diagnosis of jejunal adenocarcinoma, intermittent generalized abdominal pain, occasional vomiting, weight loss and postprandial fullness of two months of evolution. The patient was admitted with intestinal obstruction, with an abdominopelvic tomography showing abrupt caliber reduction at the level of the proximal jejunum. A laparotomy was performed, where an obstructive lesion was evidenced in the jejunum; resection was performed primary anastomosis. Histopathology reported moderately differentiated adenocarcinoma T3N0M0. The patient has had a favorable evolution

A Surgically Resected Large Sarcomatoid Carcinoma of the Jejunum: A Case Report and Literature Review

Sarcomatoid carcinoma of the small intestine is rare, and only 30 cases have been reported to date. This disease generally exhibits a very poor prognosis. Here we report the case of a 67-year-old man with a sarcomatoid carcinoma in the jejunum, who was hospitalized for diarrhea, fever, nausea, and vomiting. The tumor was located at the jejunum and had a large round shape with geographic necrosis. It involved the entire wall of the small intestine and had directly invaded the neighboring sigmoid colon. Both lobes of the liver had multiple metastases. The patient underwent surgical resection of the jejunum. On immunohistochemical analysis, the tumor was positive for epithelial and mesenchymal markers. The patient died from rapid progression of the liver metastases 6 weeks after the surgery.

Clinical Characteristics of Lower Gastrointestinal Cancer in Crohn's Disease: Case Series of 5 Patients

Crohn's disease is a chronic inflammatory disease that can involve the entire gastrointestinal tract. Several studies indicate that Crohn's patients with long disease duration have an increased risk of small bowel or colorectal cancer. In Korea, only a few cases of Crohn's disease-related small bowel or colorectal cancer have been reported. Here, we described 3 cases of colorectal cancer and 2 cases of small bowel cancer in patients with Crohn's disease. Among 5 patients, 3 had Crohn's disease-related lower gastrointestinal malignancy and the other 2 had sporadic lower gastrointestinal malignancies. Since the diagnosis of Crohn's disease-related lower gastrointestinal malignancy tends to be delayed, the development of malignancy should be considered in patients with long duration of Crohn's disease if patients have refractory symptoms despite intensive medical treatment. Surgical consultation should not be delayed.

Clinical value of spiral CT in diagnosis of small bowel tumors / 中国基层医药

Objective To explore the clinical vaue of multilayer spiral CT in diagnosis of small intestinal tumor.Methods 36 cases with small intestinal tumor were selected as the research objects,the multi-slice spiral CT imaging results were analyzed retrospectively.Results Sensitivity of multi-slice spiral CT was 94.4％,accuracy of 88.9％.Conclusion Spiral CT is a safe,simple,non-invasive,effective method in diagnosis of small bowel tumors,it has high detection rate.

A Case of Primary Jejunal Mucinous Adenocarcinoma Diagnosed by Single Balloon Enteroscopy / 대한소화기내시경학회지

The small bowel rarely develops neoplasm, and tumor of the small bowel accounts for only 1~2% of all gastrointestinal neoplasm. Most cases of jejunal and ileal adenocarconoma are of the well or moderately differentiated type. Mucinous adenocarcinoma is diagnosed when the amount of extracellular mucin in a tumor is over 50% and its incidence in the small bowel is very low. A 49-year-old man presented with postprandial abdominal pain and vomiting for the previous 2 months. The abdominal computed tomography scan showed about a 6.5 cm-sized mass at the proximal jejunum. Single balloon enteroscopy was done preoperatively for making the diagnosis and the biopsy showed mucinous adenocarcinoma of the proximal jejunum. Under the diagnosis of primary jejunal cancer. We report here on our case for which a definite diagnosis was made before surgery by performing single balloon enteroscopy, and we review the relevant medical literature.

Anemia refractaria por leiomiosarcoma de intestino delgado.: Reporte de un caso / Refractory anemia by leiomyosarcoma of small intestine.: A case report

El adenocarcinoma de intestino delgado es un tumor infrecuente en la práctica clínica. Se presenta el caso de un hombre de 50 años que ingresó en el hospital en varias ocasiones por anemia refractaria al tratamiento. En el último ingreso se detectó una tumoración en región umbilical con nódulos de hermana María y José. Se realizó laparotomía exploratoria, se detectó un tumor de intestino delgado como causa de la anemia por sangrado digestivo. El diagnóstico anatomopatológico fue de un adenocarcinoma de yeyuno de bajo grado.

The adenocarcinoma of small intestine is an infrequent tumor in the clinical practice. A case of a 50 years old man is presented, admitted in the hospital in several occasions by refractory anemia to the treatment. In his last admission an umbilical region tumour with sister Mary's and Joseph's nodules was detected. Exploratory laparotomy was carried out, an small intestine tumor was detected as cause of the anemia by digestive bleeding. The anatomicopathological diagnostic was a low-grade jejunal adenocarcinoma.

A Case of Primary Jejunal Adenocarcinoma Diagnosed by Enteroscopy using Pediatric Colonoscope / 대한소화기학회지

A 39-year-old man presented with dizziness and melena for 2 months. Abdominal CT scan showed constrictive wall thickening with enhancement and proximal loop dilatation of the jejunum. On endoscopic examination, there was large amount of bile stained fluid in duodenum. Enteroscopy using pediatric colonoscope demonstrated an encircling mass with obstruction approximately 20 cm distal to the ligament of Treitz. Endoscopic jejunal biopsy showed moderately differentiated adenocarcinoma. Small intestinal adenocarcinoma is uncommonly encountered in clinical practice. Because small intestine is relatively inaccessible via routine endoscopy, diagnosis of small intestinal neoplasm is often delayed for several months after the onset of symptoms. Most of the patients are diagnosed in advanced stage. Therefore, when a small bowel neoplasm is suspected, enteroscopy is the most useful study. If enteroscope is not available, enteroscopy using pediatric colonoscope may permit earlier preoperative diagnosis. We report a case of primary jejunal adenocarcinoma diagnosed by endoscopic biopsy using pediatric colonoscope.

Linfoma primario de yeyuno / Yeyunum primary lymphoma

Se presenta un caso de linfoma linfocítico bien diferenciado, en un paciente de cuarenta años que comenzó clínicamente con dolor abdominal difuso y diarreas, acompañándose de fiebre elevada y gran pérdida de peso, igualmente se constató al examen físico tumoración abdominal. Se señala la importancia de las exploraciones complementarias en esta entidad, asi como el tratamiento indicado en estos procesos.

A case of well differentiated lymphocytic lymphoma in a forty year old man is presented, which began clinically with diffused abdominal pain and diarrhea, together with high fever and great loss of weight. Also the physical examination showed an abdominal tumor. The importance of complementary exploration in this disease is pointed out, as well as the treatment indicated in this case.