SILENT UNTIL IT BURSTS: JEJUNAL ADENOCARCINOMA LEADING TO INTESTINAL PERFORATION – CASE REPORT filipavcpinto@gmail.com

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SILENT UNTIL IT BURSTS: JEJUNAL ADENOCARCINOMA LEADING TO INTESTINAL PERFORATION – CASE REPORT

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Hugo Capote Hugo.Capote@ulsaale.min-saude.pt Hospital Doutor José Maria Grande Portalegre Portugal

Portugal

Oral or Poster

Small bowel neoplasms are rare, accounting for less than 2% of all gastrointestinal malignancies. However, their incidence has been increasing. Adenocarcinoma is the most frequent histological subtype (30–40% of cases). Clinical manifestations are often vague and nonspecific, including abdominal pain, weight loss, intestinal obstruction, and gastrointestinal bleeding. Perforation is an uncommon presentation.

Clinical case presentation and a review of the relevant literature.

A 69-year-old male presented to the emergency department with pallor and fatigue. On admission, physical examination was unremarkable; laboratory testing revealed a hemoglobin level of 5.5 g/dL. He was admitted for evaluation of anemia. On the sixth day of hospitalization, the patient developed abdominal pain with signs of peritoneal irritation. Computed tomography of abdomen and pelvis revealed pneumoperitoneum and dilated small bowel loops. An exploratory laparoscopy identified two distinct perforations: one located 20 cm distal to the ligament of Treitz and another 40 cm proximal to the ileocecal valve. Segmental resections of the jejunum and ileum were performed, followed by hand-sewn, end-to-end anastomoses. Histopathological analysis confirmed jejunal adenocarcinoma. Despite appropriate surgical and supportive management, the patient died on postoperative day 11.

The diagnosis of small bowel adenocarcinoma remains challenging. A high index of suspicion is warranted in patients with unexplained abdominal pain or anemia. Delayed diagnosis is associated with poorer prognosis. Surgical resection remains the cornerstone of curative treatment. This case highlights an exceptionally rare presentation of jejunal adenocarcinoma with perforations at two distinct sites within the small intestine, underscoring the need for early recognition and intervention.