Gastric Signet Ring Cell Adenocarcinoma Presenting as Intermittent Volvulus of Small Bowel: A Case Presentation and Review of the Literature.

Signet ring cell carcinoma (SRCC) is an uncommon and poorly differentiated tumor. It arises mostly in the gastrointestinal tract. The incidence of gastric SRCC has increased in the past few years. Volvulus is the twisting of the bowel around its mesentery. It is classified as either primary or secondary. It is relatively common in the cecum and sigmoid colon. Volvulus of other parts of the gastrointestinal tract is relatively rare. Herein, we present a case of small bowel volvulus (SBV) secondary to advanced gastric SRCC with peritoneal carcinomatosis. The patient had presented with nausea and vomiting. Initial computed tomography (CT) scan of abdomen unveiled jejunal volvulus. SBV resolved spontaneously on a repeat CT scan. Enteroscopy with histopathology confirmed the diagnosis of gastric SRCC, which turned to be metastatic to peritoneum on laparoscopy. We believe our case is unique due to the rarity of advanced gastric SRCC presenting as secondary jejunal SBV without appreciated gastric mass on imaging.