Tow Cases of Primary Small Intestinal Cancer

Kei Koide, Yoshitaka Kato, Rokuro Seiko, Yoshio Miura, Taro Okamoto, Toshio Noriyuki, Toshiyuki Iwamoto*

Department of Surgery, Hiroshima General Hospital of West Japan Railway Company
*Department of Pathology, Hiroshima General Hospital of West Japan Railway Company

Primary small intestinal cancer is a relativery rare disease. Recently we experienced two cases in which a diagnosis of primary small intestinal cancer was made before surgery. In case l the patient was a 59-year-old man. He presented symptoms of ileus and examination revealed a high CA19-9 value. Radiographic study revealed circum ferential stenosis of the jejunum 10 cm distal from Treitz's ligament. At the operation a jejunal tumor and multiple small metastatic lesions in the mesentrium were fund. Partial resection of the jejunum was performed, but the patient died 1 year and 5 months later. In case 2 the patient was a 53-year-old woman. She had been treated for a duodenal ulcer for about 6 months because of epigastralgia, nausea, and vomiting, but came to present. She gradually developed symptoms of ileus. Radiographic study revealed an obstruction near the distal end of the jejunum. The tumor was located at the distal jeunum 130 cm from Treitz's ligament, with a napkin-ring constriction. Peritoneal dissemination was also seen. Partial resection of the jejunum was performed, but the patient died 1 year and 11 months later. Radiographic studies, especially computed tomography, selective angiography and small intestinography were useful for preoperative diagnosis in these two cases before surgery.

Key words
primary small intestinal cancer, napkin ring constriction

Reprint requests
Kei Koide Department of Surgery, Hiroshima General Hospital of West Japan Railway Company
3-1-36 Futabanosato, Higashiku, Hiroshimashi, 732 JAPAN

Accepted
September 12, 1990

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