Fedele S, Delvecchio A, De Giorgi C, Duda L, Guglielmi A, Martines G
G Chir. 2018 Nov-Dec;39(6):383-387.
Complication of Crohn's disease (CD) of the small intestine is small bowel adenocarcinoma (SBA). A lot of studies on Crohn's disease have estimated the increased relative risk of small bowel carcinoma compared to the general population. In clinical settings, it is difficult to detect SBA in CD, therefore most of cases are diagnosed after surgery for strictures without suspicion of malignancy.
The present case concerns a 48-year-old man with a suspicious 5-year history of untreated chronic inflammatory bowel disease. The patient was admitted to our unit with persistent abdominal pain, 20 kg weight loss and intestinal obstruction, confirmed at CT scans. It was performed an emergency laparotomy, terminal ileus was resected and intestinal continuity was restored. Histological examination revealed a poorly differentiated adenocarcinoma.
The risk factors of SBA include long-standing and extensive Crohn's disease, young age, male sex, smoke, early onset, complications such as strictures and fistulas The most common clinical presentation of small bowel carcinoma in Crohn's disease is intestinal obstruction accompanied by wheight loss. The diagnosis is very difficult because imaging techniques may not be able to differentiate areas of small bowel carcinomas from benign fibrotic or acute inflammatory strictures.
Small bowel adenocarcinoma is a rare disease but this evenience must be considered in patients with strictures for Crohn's disease. Preoperative diagnosis is still highly challenging despite significant radiological and endoscopic progress.
小肠克罗恩病（CD）的并发症是小肠腺癌（SBA）。许多关于克罗恩病的研究已经估计了与普通人群相比小肠癌相对风险的增加。在临床环境中，很难在克罗恩病中检测到SBA，因此大多数病例是在因狭窄进行手术且未怀疑有恶性肿瘤后才被诊断出来的。
本病例涉及一名48岁男性，有长达5年未经治疗的慢性炎症性肠病可疑病史。该患者因持续性腹痛、体重减轻20公斤和肠梗阻入院，CT扫描证实了这些情况。进行了急诊剖腹手术，切除了末端回肠梗阻段并恢复了肠道连续性。组织学检查显示为低分化腺癌。
SBA的危险因素包括长期广泛的克罗恩病、年轻、男性、吸烟、发病早、有狭窄和瘘管等并发症。克罗恩病中小肠癌最常见的临床表现是伴有体重减轻的肠梗阻。诊断非常困难，因为成像技术可能无法区分小肠癌区域与良性纤维化或急性炎症性狭窄。
小肠腺癌是一种罕见疾病，但对于患有克罗恩病狭窄的患者必须考虑到这种可能性。尽管放射学和内镜检查有了显著进展，但术前诊断仍然极具挑战性。
