A Case Report on Multifocal Small Bowel Adenocarcinoma Presenting as Multiple Strictures Mimicking Tuberculosis

Abstract

Aim: This article tries to highlight the importance of suspecting Small bowel adenocarcinoma in a patient with multifocal small bowel strictures in tuberculosis endemic regions like India.  Objective: The management of Small bowel adenocarcinoma is radically different from that of Intestinal tuberculosis and hence this article tries to highlight the importance of suspecting malignancy in a patient with multifocal strictures of small bowel even in the absence of the proposed classical risk factors for small bowel malignancy. Presentation of the Case: A 54 year old male presented with colicky central abdominal pain for 4 months. Initial evaluation suggested the possibility of Intestinal tuberculosis. He presented again 2 weeks later with acute intestinal obstruction and was taken up for emergency surgery which revealed multiple non passable strictures in jejunum and ileum which were resected and multiple anastomoses were done. Biopsy revealed multifocal primary small bowel adenocarcinoma without any evidence of predisposing factors for small bowel adenocarcinoma.  Discussion: Acute intestinal obstruction is one of the commonest indications for emergency laparotomies. Obstruction secondary to small bowel strictures in the Indian subcontinent is most commonly due to Intestinal Tuberculosis with Crohn’s disease being a distant second entity. Small bowel adenocarcinoma is not only rare but also presents with nonspecific findings making it difficult to diagnose. Surgical resection is the cornerstone of management and standard chemotherapy regimens are still evolving. Small bowel adenocarcinoma most commonly presents as a solitary infiltrating mass and hence our case is very unique in its presentation as multiple malignant strictures in jejunum and ileum. Despite extensive histological and radiological evaluation of our patient, there were no known predisposing factors like Crohn’s disease or polyposis that can explain the multifocal presentation of small bowel adenocarcinoma. Conclusion: Even with all the latest advancement in the field of diagnostics, preoperative diagnosis of small bowel adenocarcinoma is still uncommon. We are reporting this case to stress the importance of having a differential of small bowel adenocarcinoma in intestinal obstruction patients with multiple strictures of small bowel.&nbsp