Mirza Muhammad H, Nzewi Emeka
Department of Surgery, Cavan General Hospital, Cavan, Ireland.
J Surg Case Rep. 2022 Jun 28;2022(6):rjac300. doi: 10.1093/jscr/rjac300. eCollection 2022 Jun.
Small bowel adenocarcinoma is an uncommon surgical pathology. Due to non-specific symptoms, most cases present late and pose a challenge to diagnose. We present a case of a small bowel adenocarcinoma in a patient with coeliac disease. A female patient presented to the emergency department with a 3-week history of nausea, anorexia and intermittent bilious vomiting. It was associated with crampy abdominal pain. She was diagnosed with coeliac disease two years ago and commenced on a gluten-free diet. A subsequent computed tomography scan of abdomen and pelvis demonstrated a small bowel stricture with dilated proximal and collapsed distal bowel loops. The stricture was surgically resected followed by primary anastomosis. Histology confirmed adenocarcinoma with nodal metastasis. She received adjuvant chemotherapy and recovered well. In general, small bowel adenocarcinomas are rare and a high index of suspicion is required in patients with predisposing factors e.g. coeliac disease.
小肠腺癌是一种不常见的外科病理学疾病。由于症状不具特异性，大多数病例就诊时已属晚期，诊断颇具挑战。我们报告一例患有乳糜泻的小肠腺癌患者。一名女性患者因3周的恶心、厌食和间歇性胆汁性呕吐病史就诊于急诊科。伴有痉挛性腹痛。她两年前被诊断为乳糜泻，并开始采用无麸质饮食。随后的腹部和盆腔计算机断层扫描显示小肠狭窄，近端肠袢扩张，远端肠袢塌陷。通过手术切除狭窄段并进行一期吻合。组织学证实为腺癌伴淋巴结转移。她接受了辅助化疗，恢复良好。一般来说，小肠腺癌较为罕见，对于有易感因素（如乳糜泻）的患者需要高度怀疑。
