University of Mississippi Medical Center, Jackson, MS,USA.
West Afr J Med. 2020 Dec;37(7):832-835.
Invasive adenocarcinoma of the ileum is a rare tumor with an incidence of 0.59 per 1 million. Given its location in the distal portion of the small bowel, it is difficult to diagnose early and is often only discovered during surgery. This challenge leads to late diagnoses and poor prognosis. Surgical resection is the gold standard for treatment, with adjuvant therapy occasionally playing a supporting role. We present the case of a 62-year-old male with a complex past medical history, including non-small cell lung cancer with metastases to brain and treated with irradiation and left parietal craniotomy 13 years prior to presentation. Our patient presented to a community hospital complaining of abdominal pain. Findings on abdominal computerized tomography (CT) with intravenous (IV) contrast was consistent with a mechanical obstruction of the small bowel. The patient was admitted to the general medical floor for non-operative management. However, after three days of unsuccessful non-operative management, he was taken to the operating room for diagnostic laparoscopy. Surgery revealed an obstructing mass in the distal third of the ileum, which was excised and found to be invasive adenocarcinoma on histology. Adenocarcinoma of the ileum is very difficult to diagnose preoperatively. As a result, it often leads to delays in treatment and a poor prognosis in many patients, including ours. Because of its very low prevalence, a high index of suspicion is required to make an early diagnosis and obtain definitive treatment.
回肠浸润性腺癌是一种罕见的肿瘤，发病率为每百万分之 0.59。由于它位于小肠的远端，因此早期诊断很困难，通常只有在手术中才能发现。这一挑战导致了晚期诊断和预后不良。手术切除是治疗的金标准，辅助治疗偶尔起支持作用。我们报告了一例 62 岁男性的病例，他有复杂的既往病史，包括非小细胞肺癌伴脑转移，并在就诊前 13 年接受了放疗和左顶骨开颅手术。我们的患者因腹痛到社区医院就诊。腹部 CT（静脉注射造影剂）的结果与小肠机械性梗阻一致。患者被收入普通内科病房进行非手术治疗。然而，经过三天不成功的非手术治疗后，他被送往手术室进行诊断性腹腔镜检查。手术发现回肠远端三分之一处有一个阻塞性肿块，切除后发现组织学为浸润性腺癌。回肠腺癌在术前很难诊断。因此，它经常导致许多患者（包括我们的患者）治疗延迟和预后不良。由于其发病率非常低，因此需要高度怀疑才能早期诊断并获得明确的治疗。
