Small bowel obstruction caused by multiple malignant strictures; an unusual presentation of malignancy of pancreaticobiliary origin: A case report
Don Kasun Tharaka Kuruwitaarachchi ,
Post Graduate Institute of Medicine, LK
About Don Kasun Tharaka
Registrar, Orthipedic surgery, Post graduate institute of medicine, University of Colombo
National Hospital of Sri Lanka, LK
Consultant surgeon, National hospital of Sri Lanka
Background: Malignant metastasis causing small intestinal obstruction is extremely rare. Such cases mostly denote peritoneal involvement with generalized spared of the disease. Commonest cause for malignant small bowel obstruction is metastatic intersuceseption. We present a case of multiple malignant strictures causing small bowel obstruction. Immunohistochemistry is helpful in identifying the site of origin of metastatic small bowel disease with unknown primary, which is vital for the definitive management. Case presentation: We report a 65 year old male with no past surgical history presented with worsening abdominal pain and vomiting for three days. Examination revealed tender abdomen, with no peritoneal signs. Urgent USS and CECT showed dilated small intestine with possible obstruction. Emergency exploratory laparotomy revealed two short segments of small bowel strictures at distal jejunum with proximally distended bowel loops. Short segment of small bowel incorporating two strictures was resected out and primary side to side stapler anastomosis done. Histological assessment and immunohistochemistry (IHC) showed malignant cellular infiltrate with strong diffuse cytoplasmic positivity for cytokeratine (CK) 7 and CK 19 suggestive of multiple malignant strictures of the small intestine from pancretico-biliary primary. Conclusion: Patients presenting with signs of small bowel obstruction without prior laparotomy or incarcerated abdominal hernia are possible candidates for malignant intestinal obstruction. Pancretico-biliary malignancies can rarely present with small bowel obstruction due to its unusual intra-abdominal spread causing malignant intestinal strictures.
How to Cite:
Kuruwitaarachchi DKT, Gunasekara M. Small bowel obstruction caused by multiple malignant strictures; an unusual presentation of malignancy of pancreaticobiliary origin: A case report. Sri Lanka Journal of Surgery. 2023;39(2):None.
31 Jul 2023.