Primary jejunal adenocarcinoma: a case report

Introduction and importance: Primary small bowel adenocarcinoma (SBA) accounts for fewer than 2% of all gastrointestinal tumors, and only 13–20% arise in the jejunum. Vague symptoms and limited endoscopic access hinder timely diagnosis, resulting in presentation at an advanced stage. Case presentation: A 55-year-old woman presented with 6 months of peri-umbilical pain, post-prandial vomiting, and 5 kg weight loss. Anemia (hemoglobin = 9.5 g/dL) prompted further evaluation. Esophago-gastro-duodenoscopy was unremarkable. Contrast-enhanced computed tomography revealed a 25 mm circumferential thickening of the proximal jejunum. Double-balloon enteroscopy demonstrated an ulcerative, stenotic mass; biopsies confirmed a moderately differentiated adenocarcinoma. Radical segmental resection with hand-sewn end-to-end anastomosis was performed. Histology showed pT2N0M0 (Stage I) adenocarcinoma with 0 of 12 lymph nodes involved. The postoperative course was uneventful. Clinical discussion: Jejunal SBA typically manifests between 50–60 years of age and carries a poorer prognosis than colorectal cancer owing to diagnostic delay. Current evidence, largely retrospective, supports wide segmental resection with at least eight lymph nodes examined. Adjuvant chemotherapy is considered for lymph node-positive disease. This case illustrates that prompt cross-sectional imaging followed by deep enteroscopy can secure a diagnosis amenable to resection, even in resource-limited settings. Conclusion: Persistent, unexplained abdominal symptoms warrant small bowel evaluation. Early surgical intervention offers the best chance of cure.