Jejunal adenocarcinoma with concomitant enterolith presenting as acute intestinal obstruction.
An enterolith is an infrequent clinical entity. It is generally diagnosed on imaging or at surgery. It is usually associated with underlying benign lesions like intestinal tuberculosis or Crohn's disease. Here, we report an unusual case of an elderly lady presenting with an acute small-bowel obstruction. On admission, her abdominal X-ray revealed a radio-opacity obstructing the jejunum. Her subsequent abdominal contrast-enhanced computed tomography revealed a big enterolith entrapped in a stricturous jejunal lesion. However, there was no pneumobilia. Consequently, she underwent an exploratory laparotomy followed by an "en-block" jejunal resection for suspiciously malignant impassable jejunal stricture. The cutopen specimen revealed 5 x 4 cm enterolith embedded in a tight ulcero-proliferative stricture. Histopathology confirmed jejunal adenocarcinoma. It is always prudent to suspect an underlying small-bowel malignancy while managing a seemingly straightforward case of small-bowel obstruction. The policy of prophylactic radical oncologic clearance may avoid inadvertent R1/R2 resections.
Department of General Surgery, Jagjivanram Western Railway Hospital, Mumbai Central, Mumbai-400008, Maharashtra, India.
Sudeep Pradeep
SP
Yadav
Department of General Surgery / GI Surgery, Jagjivanram Western Railway Hospital, Mumbai Central, Mumbai-400008, Maharashtra, India.
Priyadarshan Anand
PA
Jategaonkar
Department of General Surgery, Jagjivanram Western Railway Hospital, Mumbai Central, Mumbai-400008, Maharashtra, India.
Aayush
A
Goyal
Department of General Surgery, Jagjivanram Western Railway Hospital, Mumbai Central, Mumbai-400008, Maharashtra, India.
Dinesh
D
Kamath
D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D002137:Calculi / Q000209:etiology*; D003251:Constriction, Pathologic / Q000150:complications; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007580:Jejunal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome