Primary adenocarcinoma arising from ileo-cecal junction presented with a component of ileo-ileal intussusception

Abstract

Primary adenocarcinoma arising from small bowel is a rare entity account 1-2% of all GIT malignancies. Adenocarcinoma is the second most malignant lesion of the small bowel after carcinoid tumour followed by lymphoma and GISTs. Duodenum is the common site followed by jejunum and ileum within the small bowel. About 48years old male presented with symptoms and signs of intestinal obstruction i.e. pain and distension of the abdomen with bilious vomiting and absolute constipation. Case was diagnosed as intestinal obstruction provisionally. USG reported as ileocecal intussusceptions with mesenteric lymphadenopathy and was confirmed by CECT. After laparotomy, growth was found at ileocecal junction. Right hemicolectomy along with lymphadenectomy was done and specimen sent for HPE. HPE revealed well differentiated adenocarcinoma, arising from terminal ileum at ileocecal junction with ileo-ileal intussusception. Small bowel adenocarcinoma is rare, further rare in ileocecal junction, radiologically presented as ileo-cecal intussusception. However, lymph nodal enlargement put us in diagnostic dilemma. Author are interested to report this case because of its rarity (incidence of adenocarcinoma terminal ileum is extremely rare and presentation as intussusception is diagnostic challenging.