The adenocarcinoma of the small intestine is a rare tumor of all gastrointestinal cancers often occurs on a predisposing ground we report the case of a 40-year-old patient chronic smoker has 1 pack year weaned 2 years ago, alcoholic weaned 5 years ago whose symptomatology dates back to 3 months by the appearance of epigastralgia and vomiting post prandial, Complicated by a high occlusive syndrome made of post prandial vomiting with abdominal pain all evolving in a context of alteration of general state made the patient was addressed to the service of digestive cancer surgery and liver transplantation of CHU Ibn Rochd Casablanca.
The patient had an abdominal CT scan which showed duodenojejunal distension with incarceration of an undistended loop at the level of the aorto-mesenteric clamp.
The patient was sent to the operating room in emergency, he underwent a segmental Greco-Resection of 15 cm taking away a jejunal mass under laparoscopy with extra corporal anastomosis latero-lateral jejuno-jejunal with at the exploration one notes the presence of a tumoral mass of 3cm mobile at the level of the 2nd loop jejunal stenosing responsible for a jejunal distension upstream measuring 4cm in diameter.
The anatomopathological study of the specimen showed a moderately differentiated and invasive adenocarcinoma, classified as pT3N1Mx.
The postoperative follow-up was marked by a deep venous thrombosis involving the ileo-femoral-popliteal axis of the ilio-femoral-popliteal trunk on day 2 postoperatively, for which the patient was put on low molecular weight Heparin at a curative dose with compression stockings and monitoring.
The patient had resumed transit in the form of gas on postoperative day 3, with a correct assessment, and was declared discharged on postoperative day 6.
The patient's file was discussed in a multidisciplinary consultation meeting and the decision was to undergo adjuvant chemotherapy and oesogastroduodal fibroscopy (FOGD) and colonoscopy to look for predisposing diseases.
Ofori E, Ramai D, Papafragkakis C, Changela K, Krishnaiah M. Primary Jejunal Adenocarcinoma Presenting as Bilateral Ovarian Metastasis. Gastroenterol Res. 2017;10(6):366‑8.
Vilde F, Wdowik A. Adénocarcinome du jé junum: apport de l’enteroscopie poussée. A propos d’un cas. Acta Endosc. 1996;26:5.
Chang H-K, Yu E, Kim J, Bae YK, Jang K-T, Jung ES, et al. Adenocarcinoma of the small intestine: a multi-institutional study of 197 surgically resected cases. Hum Pathol. août 2010;41(8):1087‑96.
Zaanan A, Afchain P, Carrere N, Aparicio T. Adénocarcinome de l’intestin grêle. Gastroentérologie Clin Biol. août 2010;34(6‑7):371‑9.
Delaunoit T, Neczyporenko F, Limburg PJ, Erlichman C. Small Bowel Adenocarcinoma: A Rare but Aggressive Disease. Clin Colorectal Cancer. nov 2004;4(4):241‑8.
Halima A, Maha M, Issam L, Hind M, Hassan E. Les tumeurs malignes primitives de l’intestin grêle: aspects cliniques et thérapeutiques de 27 patients:7.
Mellouki I, Jellali K, Ibrahimi A. Les tumeurs du gréle: à propos de 27 cas. Pan Afr Med J [Internet]. 2018 [cité 25 avr 2021];30. Disponible sur: http://www.panafrican-med-journal.com/content/article/30/13/full/.
Aparicio T. Small bowel adenocarcinoma: Epidemiology, risk factors, diagnosis and treatment. Dig Liver Dis. 2014;8.
Katrina S. Pedersen, MD, MSa; Kanwal Raghav, MBBS, MDb; and Michael J. Overman, MDb. Small Bowel Adenocarcinoma: Etiology, Presentation, and Molecular Alterations in: Journal of the National Comprehensive Cancer Network Volume 17 Issue 9 (2019).
Chapitre 13: Adénocarcinome de l’intestin grêle. Thésaurus national de cancérologie digestive. 2017.
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