title: Computed Tomographic presentation of obstructive jejunal adenocarcinoma associated with celiac disease and incomplete intestinal malrotation.
abstract: BACKGROUND
  Small bowel adenocarcinoma is a rare entity most frequently observed with celiac disease. This is the first case report on the association of celiac disease, small bowel adenocarcinoma and intestinal malrotation.
  
  
  METHODS
  A 40 year-old male patient diagnosed with celiac disease since the age of 5 years complained of epigastric pain and vomiting for three days. Computed tomography (CT) showed a significant gastroduodenal dilatation with thickened intestinal wall proximal to the duodenojejunal flexure. The lumen contained a food bezoar in the center. The duodenojejunal angle was abnormally on the right side of the abdomen and the superior mesenteric vein was anterior to the superior mesenteric artery. Endoscopy after aspiration found a hemi-circumferential and irregular mass which bled at the contact of fibroscope. Biopsies showed an adenocarcinoma and small bowel resection was performed.
  
  
  CONCLUSIONS
  Celiac disease is associated with a high risk of small bowel cancer. The association of incomplete intestinal malrotation, duodenojejunal flexure tumor and celiac disease made the surgery challenging.
  
  
  CONCLUSIONS
  Patients with celiac disease should be carefully monitored and endoscopic or radiologic investigations should be carried out in patients with any doubtful symptoms.
authors.affiliation: Department of Radiology, Mongi Slim University Hospital Marsa, Tunisia. Electronic address: marzouk.ines@gmail.com.
authors.forename: Marzouk Moussa
authors.initials: MM
authors.lastname: Ines
authors.affiliation: Department of Gastroenterology, Mongi Slim University Hospital Marsa, Tunisia.
authors.forename: Rym
authors.initials: R
authors.lastname: Ennaifer
authors.affiliation: Department of Surgery, Mongi Slim University Hospital Marsa, Tunisia.
authors.forename: Sahir
authors.initials: S
authors.lastname: Omrani
authors.affiliation: Department of Pathology, Mongi Slim University Hospital Marsa, Tunisia.
authors.forename: Lahmar Boufaroua
authors.initials: LB
authors.lastname: Ahlem
authors.affiliation: Department of Radiology, Mongi Slim University Hospital Marsa, Tunisia.
authors.forename: Rym
authors.initials: R
authors.lastname: Ouji
authors.affiliation: Department of Radiology, Mongi Slim University Hospital Marsa, Tunisia.
authors.forename: Lotfi
authors.initials: L
authors.lastname: Hendaoui
keywords: Adenocarcinoma; Celiac disease; Computed tomography; Endoscopy; Intestinal malrotation; Intestinal obstruction