Small Intestine Carcinoma with Multiple Metastasis Presenting as a Small Bowel Obstruction Due to a Dried Plum Stone：Report of a Case

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  • Yamasaki Yasushi
    Department of Surgery, Tokai University School of Medicine, Tokyo Hospital
  • Chino Osamu
    Department of Surgery, Tokai University School of Medicine, Tokyo Hospital
  • Hanashi Tomoko
    Department of Surgery, Tokai University School of Medicine, Tokyo Hospital
  • Tanaka Yoichi
    Department of Surgery, Tokai University School of Medicine, Tokyo Hospital
  • Makuuchi Hiroyasu
    Tokai University School of Medicine

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  • 種子による腸閉塞を契機に発見された多発転移を伴う原発性小腸癌の1例

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Abstract

<p>A 66-year-old man was admitted to our hospital because of anemia and passage of dark tarry stools. Upper and lower gastrointestinal (GI) endoscopy did not reveal any bleeding. Chest computed tomography (CT) showed lymph nodes enlargement extending from the anterior mediastinum to the right supraclavicular region. 18F-Fluorodeoxyglucose positron emission tomography revealed high uptake at the anterior mediastinum to the right supraclavicular lymph nodes, duodenum, and lumbar vertebra. Repeat upper GI endoscopy showed a lesion in the descending portion of the duodenum, which was subsequently diagnosed pathologically by biopsy as a poorly differentiated adenocarcinoma. The patient was discharged, but was later readmitted with abdominal pain. CT revealed a small bowel obstruction (SBO) caused by a foreign body with incarceration of the small intestine and wall thickening. He had unintentionally swallowed a dried plum stone a few days earlier. Emergency surgery was performed for refractory SBO managed conservatively with an ileus tube. Intra-operative findings showed cancerous stenosis and intramural metastasis of the small intestine. Thus, the definitive diagnosis based on histopathological findings was a small intestinal adenocarcinoma with multiple lymph node and duodenal metastasis. Small intestine carcinomas are rare. This is the rare report of a case in Japan of a small intestine carcinoma with multiple metastasis presenting as small bowel obstruction due to a dried plum stone.</p>

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