Splenic metastasis from small bowel adenocarcinoma

Small bowel adenocarcinoma is a rare malignancy, often diagnosed at advanced stages due to nonspecific symptoms. Common metastatic sites include the liver and peritoneum, while splenic involvement has not been previously documented. We report the case of a 42-year-old woman with chronic anemia and dyspepsia, who later presented with overt gastrointestinal bleeding. Imaging revealed a stenotic jejunal lesion, hypermetabolic mesenteric lymphadenopathy, and a hypermetabolic splenic nodule on positron emission tomography-computed tomography (PET/CT). She underwent laparoscopic segmental jejunal resection with lymphadenectomy, followed by laparoscopic splenectomy. Histopathology confirmed a moderately differentiated adenocarcinoma with nodal involvement (pT3 pN2) and an enteric-type adenocarcinoma infiltrating the spleen. The patient recovered uneventfully and is scheduled for adjuvant chemotherapy. This case highlights the diagnostic challenges of small bowel adenocarcinoma, the role of PET/CT in staging, and the feasibility of laparoscopic splenectomy for rare isolated splenic metastases. Long-term follow-up will determine its prognostic impact.