DOI: http://dx.doi.org/10.18203/2349-2902.isj20213149

Adenocarcinoma ileum: a rare cause of ileal stricture mimicking intestinal tuberculosis: a case report and literature review

Manisha Aggarwal, Dinesh Manchikanti, Janitta Kundaikar, Shaji Thomas, Ashish Arsia, Rahul Pusuluri, Kusum Meena, Sanjay Kumar

Abstract


One of the commonest causes of small intestinal obstruction in India is tuberculosis. The terminal ileum and ileocaecal junction are the most common sites of small bowel involvement, and the most common abnormality is short-segment strictures. We report a patient who presented with small intestinal obstruction due to a solitary ileal stricture, but turned out to be a rare condition that can mimic intestinal tuberculosis. A 60-years-old man, with recurrent episodes of pain abdomen for 1 year, presented to our surgical emergency with evidence of small intestinal obstruction. A CT scan revealed a short segment stricture (2.7 cm) in mid ileal loop with luminal narrowing and marked proximal dilation of proximal ileal loops with a few sub centimetric mesenteric lymph nodes. On laparotomy with a suspected diagnosis of intestinal tuberculosis, it turned to be an adenocarcinoma of the ileum- a rare condition that can mimic intestinal tuberculosis. One of the commonest causes of small intestinal obstruction in India is abdominal tuberculosis. However, all cases of small intestinal obstruction are not tuberculosis. Adenocarcinoma of ileum is a very rare entity. This case report shows that a surgeon should have a high index of suspicion in an elderly patient presenting with small intestinal obstruction, with CT demonstrating isolated short-segment small bowel thickening, as it could be a presentation of obstructing type adenocarcinoma of the small intestine.


Keywords


Adenocarcinoma ileum, Small intestinal obstruction, Ileal stricture, Small intestinal tuberculosis

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References


Hasnain SQ, Ahmed M. Intestinal obstruction in adults at the Aga Khan University Hospital. J Pak Med Assoc. 1994;44(6):143-5.

Kalra N, Agrawal P, Mittal V, Kochhar R, Gupta V, Nada R, et al. Spectrum of imaging findings on MDCT enterography in patients with small bowel tuberculosis. Clin Radiol. 2014;69(3):315-22.

Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res. 2004;120(4):305-15.

Nabais C, Salustio R, Sousa F, Porto E, Cardoso C, Fradique C. Adenocarcinoma of the ileum: A rare and challenging entity. Ann Med Surg. 2015;4(2):116-8.

Shenoy S. Primary small-bowel malignancy: update in tumor biology, markers, and management strategies. J Gastrointest Cancer. 2014;45(4):421-30.

Halfdanarson TR, Williams RR, Donohue JH, Quevedo JF. A single institution experience with 491 cases of small bowel adenocarcinoma. Am J Surg. 2010;199:797-803.

Bennett CM, Coleman HG, Veal PG, Cantwell MM, Lau CC, Murray LJ. Lifestyle factors and small intestine adenocarcinoma risk: a systematic review and meta-analysis. Cancer Epidemiol. 2015;39(3):265-73.

Schatzkin A, Park Y, Leitzmann MF, Hollenbeck AR, Cross AJ. Prospective study of dietary fiber, whole grain foods, and small intestinal cancer. Gastroenterology. 2008;135(4):1163-7.

Dabaja BS, Suki D, Pro B, Bonnen M, Ajani J. Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer. 2004;101(3):518-26.

Talamonti MS, Goetz LH, Rao S, Joehl RJ. Primary cancers of the small bowel: analysis of prognostic factors and results of surgical management. Arch Surg. 2002;137(5):564-70.

Laurent F, Raynaud M, Biset JM, Boisserie LM, Grelet P, Drouillard J. Diagnosis and categorization of small bowel neoplasms: role of computed tomography. Gastrointest Radiol. 1999;16(2):115.

Kumar A, Rana SS, Nada R, Kalra N, Sharma RK, Dutta U, et al. Significance of ileal and/or cecal wall thickening on abdominal computed tomography in a tropical country. JGH Open. 2018;3(1):46-51.

Gee MJL, Strauss PN. The elusive small bowel adenocarcinoma in the terminal ileum-A case report. Int J Surg Case Rep. 2018;47:97-9.

Sakae H, Kanzaki H, Nasu J, Akimoto Y, Matsueda K, Yoshioka M, et al. The characteristics and outcomes of small bowel adenocarcinoma: a multicentre retrospective observational study. Br J Cancer. 2017;117:1607-13.

Agrawal S, Carron EC, Gibbs JF, Nava HR, Wilding GE, Rajput A. Surgical management and outcome in primary adenocarcinoma of the small bowel. Ann Surg Oncol. 2007;14(8):2263-9.

Bakaeen FG, Murr MM, Sarr MG, Thompson GB, Farnell MB, Nagorney DM, et al. What prognostic factors are important in duodenal adenocarcinoma?. Arch Surg. 2000;135:635-41.

Howe JR, Karnell LH, Menck HR, Scott CC. The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995. Cancer. 1999;86(12):2693-706.

Gaitonde SG, Bilchik AJ. Adenocarcinoma of the small intestine. In: Meester SR, Matthews JB, Fleshman JW, Yeo CJ, eds. Shackelford’s surgery of the alimentary tract. 8th ed. Philadelphia, PA: Elsevier; 2019: 804-808.