Two Case Reports of Usefulness of Diffusion Weighted MRI in Diagnosing a Metachronous Small Bowel Carcinoma following a Resection of Colon Carcinoma

Tomonori Hosonuma, Masaichi Ogawa, Michiaki Watanabe, Masahiro Ikegami¹⁾, Daichi Hayashi²⁾, Kunihiko Fukuda²⁾ and Katsuhiko Yanaga

Department of Surgery, Department of Pathology¹⁾ and Department of Radiology²⁾, Jikei University School of Medicine

We report two cases in which diffusion-weighted imaging (DWI) played a major role in diagnosing primary small bowel carcinoma developing after colon cancer resection. Case 1: A 38-year-old woman undergoing transverse colectomy for transverse colon carcinoma 6 years earlier and seen for malaise and appetite loss was found in computed tomography (CT) to have circumferential thickening of the intestinal wall at the transverse colon anastomosis. The lesion presented as a high-signal area in both low and high b-value images in DWI and was thought to be a local recurrence. Upon further analysis of the same images, however, we concluded that the small bowel with a high signal area ran anteriorly to the transverse colon, yielding a diagnosis of malignant small bowel cancer. Case 2: A 71-year-old woman undergoing endoscopic mucosal resection due to ileocecal carcinoma (m) 9 years earlier and admitted for epigastric pain, appetite loss, and vomiting was found in CT to have superior mesenteric artery (SMA) syndrome for which conservative treatment was unsuccessful. DWI indicated malignant small bowel cancer extending horizontally between the duodenum and jejunum.

Key words
diffusion-weighted imaging (DWI), colon carcinoma, metachronous small bowel carcinoma

Reprint requests
Tomonori Hosonuma Department of Surgery, Jikei University School of Medicine
3-25-8 Nishi-Shimbashi, Minato-ku, 105-8461 JAPAN

Accepted
March 28, 2007

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