Small Bowel Adenomyoma: An Incidental Intraoperative Finding While Performing Hepaticojejunostomy for CBD Injury

Abstract

Adenomyoma is a benign lesion that is most commonly seen in the gallbladder, however, rare cases have been reported where this pathology was encountered in the vicinity of the gastrointestinal tract. The pathogenesis of this lesion is still a controversy, with the previous reports suggesting it to be either a form of hamartoma or incomplete heterotopic pancreas. Jejunal and ileal adenomyoma have been rarely reported, and as of 2016 less than 30 cases were reported in the English literature. The clinical presentation is variable depending on the location of the lesion. Although there are no specific management guidelines for this pathology, a surgical resection is sufficient. However, aggressive surgical approaches, such as pancreaticoduodenectomy for periampullary adenomyoma, have been undertaken in the previous reports due to the misdiagnosis with carcinoma preoperatively. We report a case of a 58-year-old gentleman who was referred to our Hepato- Pancreato-Biliary facility with common bile duct injury post laparoscopic cholecystectomy for hepatico- jejunostomy. Intra-operatively, an intra-luminal, jejunal mass was found measuring 2x2 cm and was about 95 cm from the DJ junction. The lesion was resected with safety margins, and primary anastomosis was done. The final histopathology of the specimen was consistent with adenomyoma, and all of the surgical margins were free.