The purpose of this essay is to emphasise the necessity of
detecting small bowel adenocarcinoma in patients with multifocal small
intestinal strictures in tuberculosis-endemic areas such as India.
Objective: Because the management of small bowel
adenocarcinoma differs significantly from that of intestinal tuberculosis, this
article aims to emphasise the importance of suspecting malignancy in a patient
with multifocal small bowel strictures, even if no classical risk factors for
small bowel malignancy are present.
The Case Presentation: For four months, a 54-year-old man
has been suffering from colicky central abdominal pain. Intestinal tuberculosis
was suspected at the initial examination. He presented with acute intestinal
obstruction two weeks later and was rushed to the hospital for emergency surgery,
which revealed multiple non-passable strictures in the jejunum and ileum, which
were resected and many anastomoses performed. Without any evidence of
predisposing factors for small intestine adenocarcinoma, a biopsy revealed
multifocal primary small bowel cancer.
One of the most common reasons for emergency laparotomies is
acute intestinal blockage. Intestinal Tuberculosis is the most common cause of
obstruction secondary to small bowel strictures in the Indian subcontinent,
with Crohn's disease a distant second. Small bowel adenocarcinoma is not only
uncommon, but it often presents with nonspecific symptoms, making diagnosis
difficult. The cornerstone of treatment is surgical resection, and standard
chemotherapy regimens are continually developing. Because small bowel
adenocarcinoma usually manifests as a single infiltrating mass, our case is
unusual in that it presents as several malignant strictures in the jejunum and
ileum. Despite our patient's comprehensive histological and radiological
evaluation, no known predisposing conditions, such as Crohn's disease or
polyposis, could explain the multifocal appearance of small intestinal
adenocarcinoma.
Conclusion: Despite all of the advances in
diagnostic technology, preoperative identification of small bowel cancer is
still uncommon. This case is being reported to emphasise the necessity of a
differential diagnosis of small bowel adenocarcinoma in individuals with
numerous small bowel strictures.
Author(S) Details
V. R. Karthikayan
Department of Oncosurgery, Delhi State Cancer Institute, Dilshad Garden,
Delhi- 110095. India.
Anil Kumar Singh
Department of Oncosurgery, Delhi State Cancer Institute, Dilshad Garden,
Delhi- 110095. India.
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