Louisiana State University Health Sciences Center Lafayette, LA
Ali K. Yousuf, DO1, Phillip Henderson, DO2 1Louisiana State University Health Sciences Center, Lafayette, LA; 2University of South Alabama, Mobile, AL
Introduction: Small bowel adenocarcinoma is a rare type of cancer that arises from the cells that line the small intestine. It accounts for 3% of all gastrointestinal malignancies and presents a diagnostic challenge due to its nonspecific symptoms and the difficulty in accessing the small bowel for investigation. In this case report, we present the clinical and endoscopic features of a patient with small bowel adenocarcinoma.
Case Description/Methods: We present a 48 yo male with a history of diabetes who initially presented to an outside emergency department with acute abdominal pain, constipation, and periodic dark stools. Patient was found to have iron deficiency anemia at time of evaluation, however remained hemodynamically stable. Resulting EGD/colonoscopy were inconclusive for acute causes of iron deficiency anemia and constipation. He then received a pill endoscopy which depicted an unidentifiable mass in the small intestine. He subsequently underwent balloon enteroscopy which depicted a large, fungating, friable mass in the distal ileum. The mass was tagged with staining. Biopsies of the site resulted positive for adenocarcinoma. Patient was then referred to colorectal surgery for urgent resection, and oncology for further management. Post resection pathology depicted a circumferential mass, with invasion into subserosal fat (pT3) without metastatic disease.
Discussion: It is crucial to consider small bowel adenocarcinoma as a differential diagnosis in patients presenting with abdominal pain, weight loss, gastrointestinal bleeding. Early detection and intervention can improve outcomes, but more research is needed to develop effective screening strategies for this rare malignancy. In conclusion, small bowel adenocarcinoma is a rare but aggressive malignancy that can present with non-specific symptoms, making it challenging to diagnose in an early stage. In this case, we presented a patient with unexplained constipation and iron deficiency anemia who was later found to have small bowel adenocarcinoma on small bowel balloon enteroscopy.
Figure: A: Ileal Mass 50 cm past IC Valve B: Ileal Mass 50 cm past IC Valve C: Terminal Ileal Mass
Disclosures:
Ali Yousuf indicated no relevant financial relationships.
Phillip Henderson indicated no relevant financial relationships.
Ali K. Yousuf, DO1, Phillip Henderson, DO2. P2708 - Small Bowel Adenocarcinoma: An Atypical Cause of Gastrointestinal Bleeding - A Case Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
