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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

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    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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Case Report

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A Case of Jejunal Adenocarcinoma Diagnosed by Preoperative Double Balloon Enteroscopy

Hong Joo Lee, Jae Myung Cha*, Joung Il Lee, Kwang Ro Joo, Sung Won Jung, and Hyun Phil Shin

Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.

Correspondence to: Jae Myung Cha. Department of Internal Medicine, East-West Neo Medical Center, Kyung Hee University College of Medicine, 149, Sangil-dong, Gangdong-gu, Seoul 134-727, Korea. Tel: +82-2-440-6113, Fax: +82-2-440-6295, dramc@hanmail.net

Received: March 30, 2009; Accepted: June 7, 2009

Gut Liver 2009;3(4):311-314

Published online December 31, 2009, Published Date December 31, 2009 https://doi.org/10.5009/gnl.2009.3.4.311

Copyright © Gut and Liver.

Despite a thorough history, physical examination, and complete diagnostic workup, the correct diagnosis of small-intestinal malignancy is established preoperatively in only 50% of cases; an exploratory laparotomy is often required. However, recent advances in endoscopic technologies, such as double-balloon enteroscopy (DBE), have been shown to facilitate the preoperative diagnosis of these tumors. Confirmation of malignancy using DBE in equivocal cases may greatly increase both patients' acceptance of surgery and the confidence of the physician planning a surgical resection. We describe herein the case of a 53-year-old woman with a stage I jejunal adenocarcinoma that was diagnosed by DBE and treated by laparoscopic jejunectomy. Histopathological examination revealed a stage I jejunal adenocarcinoma (T2N0M0) without muscularis propria invasion, lymphovascular invasion, or lymph-node metastasis.

Keywords: Adenocarcinoma, Double ballon enteroscopy, Jejunum

Small intestinal malignancies have been diagnosed in advanced stages due to their non-specific clinical presentations as well as difficulties with endoscopic examinations of the small intestine. In recent years, the preoperative diagnosis for small intestinal malignancy has been dramatically improved due to the advance in endoscopic technologies such as double-balloon enteroscopy (DBE).1,2 Here, we describe a 53-year-old woman with a stage I jejunal adenocarcinoma diagnosed by DBE with a review of the relevant English literature with specific reference to their diagnostic modalities.

A 53-year-old woman presented to our hospital with a 13-month history of recurrent vomiting, which aggravated in frequency 10 days ago. Other complaints included anorexia, epigastric pain, and weight loss of 3 kg over 3 months. Findings of upper endoscopy performed at a primary clinic 5 days ago were normal. Her diet, medication, and past medical history were unremarkable. She appeared well, and physical examinations showed no abnormalities. Laboratory findings revealed a white cell count of 8,900/mm3, hemoglobin of 14.1 g/dL, and hematocrit of 40.6%. Findings of routine blood chemistry, serum carcinoembryonic antigen and serum carbohydrate antigen 19-9 were within normal limits. Abdominal computed tomography (CT) revealed significant localized thickening of the jejunal wall with marked dilatation proximal to the lesion (Fig. 1), but no mass lesions or abnormal findings in other organs. The radiological impression for these CT findings was a jejunal cancer or benign stricture. As there was no clue to differentiate these two diagnoses, we decided to perform an endoscopy for the direct visualization of the lesion and a preoperative histological diagnosis, if possible. Push enteroscopy was initially performed because the lesion was observed at proximal jejunum, however, visualization of the lesion by push enteroscopy was impossible because of the acute angulation of a bowel loop. For the next step, DBE using oral route was done under the conscious sedation with an intravenous bolus injection of midazolam 2 mg and propofol 20 mg. DBE of the proximal jejunum revealed an infiltrative tumor causing concentric luminal narrowing (Fig. 2A). Extensive biopsy samples were obtained, and the tumor location was marked using a hemoclip and injecting India ink (Fig. 2B). No immediate or delayed complications occurred during DBE. Endoscopic biopsy demonstrated a moderately differentiated adenocarcinoma. Laparoscopic partial jejunectomy and removal of regional lymph nodes were performed, and a 45×25×8 mm, constricting tumor (Fig. 3) was identified at a site 20 cm distal to the ligament of Treitz. Histopathological examination revealed a stage I jejunal adenocarcinoma (T2N0M0; classified according to the American Joint Committee on Cancer staging system); without invasion through the muscularis propria, lymphovascular invasion or lymph node metastasis (Fig. 4).

Postoperatively, she was stable and discharged in satisfactory condition.

Small intestinal adenocarcinoma accounts for 0.3% of all malignancies of the gastrointestinal tract and 30% to 50% of all malignancies of the small intestine.3 Despite a thorough history, physical examination and complete diagnostic workup, the correct diagnosis of small intestinal malignancy has been established preoperatively in only 50 percent of cases, with the remainder diagnosed at exploratory laparotomy. Since clinical presentations of small intestinal adenocarcinoma are vague and non-specific, they are usually diagnosed in advanced stages. The rarity of this tumor and the difficulties with endoscopic examinations in small intestine may also attribute the delayed diagnosis. As a result, survival is generally poor, with most series reporting five-year survival rates of 20-30%.3

We reviewed reports of primary jejunal adenocarcinoma identified using a computerized search of PubMed database (articles in English between 2000 and 2009). Primary jejunal adenocarcinomas associated with Crohn's disease, celiac disease or duplication cyst were excluded in this analysis. Three cases of primary jejunal adenocarcinoma in children were also excluded. Under this definition, 20 of the cases identified by the computerized search were reviewed (Table 1).4-22 There were 10 men and 9 women with a median age of 55 years. Solitary bone metastasis and primary ovarian carcinoma was the first clinical manifestation in two of them.8,22 Seven of them were diagnosed without regional or distant metastasis, however, none of them were diagnosed in stage 1 as in our case. Approximately 45% of cases were diagnosed by exploratory laparotomy (n=9) and 45% of cases were diagnosed by endoscopy (push enteroscopy, n=6; DBE, n=2; capsule endoscopy, n=1). Recent advances in DBE may facilitate preoperative histological diagnosis of small intestinal malignancy as in our case.

In the present case, the jejunal wall thickening could be attributed to the tumor, ischemic change, or inflammation as there were no symptoms, signs, and laboratory findings suggestive of a malignancy. Although some do recommend operation for a possible jejunal cancer without preoperative histological confirmation, confirming malignancy in equivocal cases may greatly increase both the compliance of patients for an operation and confidence of the physician planning a surgical resection. DBE successfully revealed an infiltrative mass with concentric luminal narrowing and facilitated correct histological diagnosis in this case. In addition, tumor marking using India ink for the exact location during DBE was helpful for the subsequent laparoscopic resection. As only DBE allows direct, controlled visualization of small bowel tumors and its histological confirmation preoperatively, it may be considered the gold standard for the diagnosis of such tumors.

In conclusion, DBE is a safe and accurate method to make a preoperative histological diagnosis of jejunal cancer. Confirming malignancy using DBE in equivocal cases may greatly increase both the compliance of patients for an operation and confidence of the physician planning a surgical resection.

Fig. 1.Computed tomography of the abdomen revealing significant thickening (arrow) of the jejunal wall.
Fig. 2.(A) Double-balloon enteroscopy revealed a circumferential infiltrative mass in the proximal jejunum. (B) Note the submucosal India ink injection that was used to mark the tumor location to facilitate subsequent laparoscopic surgery.
Fig. 3.Macroscopic examination of the lesion revealed it to be a circumferential, infiltrative tumor measuring 45×25×8 mm.
Fig. 4.Histological examination confirmed that the tumor was a moderately differentiated adenocarcinoma, without invasion through the muscularis propria (H&E stain, ×2). There was also no lymphovascular invasion or lymph-node metastasis.


Summary of Cases with Primary Jejunal Adenocarcinoma in the English Literature between 2000 and 2009


DBE, double ballon enteroscopy; FNA, fine needle aspiration; IPC, intraperitoneal chemotherapy; PET, positron emission tomography.

*Not mentioned.

DBE, double ballon enteroscopy; FNA, fine needle aspiration; IPC, intraperitoneal chemotherapy; PET, positron emission tomography.

*Not mentioned.

  1. Keuchel, M, Hagenmuller, F. Small bowel endoscopy. Endoscopy, 2005;37;122-132.
    Pubmed
  2. Heine, GD, Hadithi, M, Groenen, MJ, Kuipers, EJ, Jacobs, MA, Mulder, CJ. Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy, 2006;38;42-48.
    Pubmed
  3. Ugurlu, MM, Asoglu, O, Potter, DD, Barnes, SA, Harmsen, WS, Donohue, JH. Adenocarcinomas of the jejunum and ileum: a 25-year experience. J Gastrointest Surg, 2005;9;1182-1188.
    Pubmed
  4. Andriessen, MJ, Govaert, MJ, de Waard, JW. Jejunojejunal intussusception by a known jejunal adenocarcinoma. Can J Surg, 2008;51;E83-E84.
    Pubmed
  5. Chen, CW, Wang, WM, Su, YC, Wu, JY, Hsieh, JS, Wang, JY. Oxaliplatin/5-fluorouracil/leucovorin (FOLFOX4) regimen as an adjuvant chemotherapy in the treatment of advanced jejunal adenocarcinoma: a report of 2 cases. Med Princ Pract, 2008;17;496-499.
    Pubmed
  6. Sakai, Y, Tsuyuguchi, T, Ohara, T, et al. A patient with adenocarcinoma of the jejunum successfully diagnosed by preoperative endoscopy for the small intestine. Hepatogastroenterology, 2008;55;1367-1369.
    Pubmed
  7. Tankova, L, Berberova, M, Damianov, N, Tsankov, T, Kovatchki, D. Preoperative diagnosis of jejunal adenocarcinoma: a case report. J BUON, 2008;13;123-126.
    Pubmed
  8. Yamada, K, Ikehara, Y, Nakanishi, H, Kozawa, E, Tatematsu, M, Sugiura, H. Solitary bone metastasis as the first clinical manifestation in a patient with small bowel adenocarcinoma. J Orthop Sci, 2007;12;606-610.
    Pubmed
  9. Baichi, MM, Arifuddin, RM, Mantry, PS. Metachronous small bowel adenocarcinomas detected by capsule endoscopy in a patient with hereditary nonpolyposis colorectal cancer. Dig Dis Sci, 2007;52;1134-1136.
    Pubmed
  10. Moirangthem, GS, Arunkumar, C, Lokendra, K, Ramesh, L, Marak, A. Jejunal carcinoma. Trop Gastroenterol, 2005;26;199-200.
    Pubmed
  11. Yen, HH, Chen, YY, Soon, MS. Primary linitis plastica of the jejunum. Gastrointest Endosc, 2006;63;503.
    Pubmed
  12. Innis, M, Sandiford, N, Shenoy, RK, Prussia, PR, Zbar, A. Carcinoma of the jejunum with multideposit peritoneal seeding, resection and intraperitoneal chemotherapy. West Indian Med J, 2005;54;242-246.
    Pubmed
  13. Akahoshi, K, Endo, S, Kubokawa, M, et al. Primary jejunal cancer. Gastrointest Endosc, 2005;62;780.
    Pubmed
  14. Hong, SJ, Kwon, KW, Ko, BM, et al. Jejunal adenocarcinoma. Gastrointest Endosc, 2005;61;430-431.
    Pubmed
  15. Soeda, J, Sekka, T, Hasegawa, S, et al. A case of primary small intestinal cancer diagnosed by laparoscopy. Tokai J Exp Clin Med, 2004;29;159-162.
    Pubmed
  16. Yamaura, G, Yoshioka, T, Kubota, K, et al. FDG PET and gallium scintigraphy for diagnosis of an advanced jejunal adenocarcinoma with distant metastases. Clin Nucl Med, 2004;29;825-827.
    Pubmed
  17. Zeebregts, CJ, Prevo, RL, Klaase, JM. Jejunojejunal intussusception secondary to adenocarcinoma. Am J Surg, 2004;187;450-451.
    Pubmed
  18. Madisch, A, Schimming, W, Kinzel, F, et al. Locally advanced small-bowel adenocarcinoma missed primarily by capsule endoscopy but diagnosed by push enteroscopy. Endoscopy, 2003;35;861-864.
    Pubmed
  19. Tanimura, S, Higashino, M, Fukunaga, Y, Osugi, H. Laparoscopy-assisted resection for jejunal carcinoma. Surg Laparosc Endosc Percutan Tech, 2001;11;287-288.
    Pubmed
  20. Gurudu, S, Isenberg, G. Small bowel adenocarcinoma. Gastrointest Endosc, 2001;53;494.
    Pubmed
  21. Inderbitzin, D, Weber, M, Cathomas, G, Largiad?r, F. Primary small bowel carcinoma: case report. Swiss Surg, 2000;6;182-183.
    Pubmed
  22. Kilic, G, Abadi, M. Jejunal adenocarcinoma presenting as a primary ovarian carcinoma. Gynecol Oncol, 2000;78;255-258.
    Pubmed

Article

Case Report

Gut Liver 2009; 3(4): 311-314

Published online December 31, 2009 https://doi.org/10.5009/gnl.2009.3.4.311

Copyright © Gut and Liver.

A Case of Jejunal Adenocarcinoma Diagnosed by Preoperative Double Balloon Enteroscopy

Hong Joo Lee, Jae Myung Cha*, Joung Il Lee, Kwang Ro Joo, Sung Won Jung, and Hyun Phil Shin

Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.

Correspondence to: Jae Myung Cha. Department of Internal Medicine, East-West Neo Medical Center, Kyung Hee University College of Medicine, 149, Sangil-dong, Gangdong-gu, Seoul 134-727, Korea. Tel: +82-2-440-6113, Fax: +82-2-440-6295, dramc@hanmail.net

Received: March 30, 2009; Accepted: June 7, 2009

Abstract

Despite a thorough history, physical examination, and complete diagnostic workup, the correct diagnosis of small-intestinal malignancy is established preoperatively in only 50% of cases; an exploratory laparotomy is often required. However, recent advances in endoscopic technologies, such as double-balloon enteroscopy (DBE), have been shown to facilitate the preoperative diagnosis of these tumors. Confirmation of malignancy using DBE in equivocal cases may greatly increase both patients' acceptance of surgery and the confidence of the physician planning a surgical resection. We describe herein the case of a 53-year-old woman with a stage I jejunal adenocarcinoma that was diagnosed by DBE and treated by laparoscopic jejunectomy. Histopathological examination revealed a stage I jejunal adenocarcinoma (T2N0M0) without muscularis propria invasion, lymphovascular invasion, or lymph-node metastasis.

Keywords: Adenocarcinoma, Double ballon enteroscopy, Jejunum

INTRODUCTION

Small intestinal malignancies have been diagnosed in advanced stages due to their non-specific clinical presentations as well as difficulties with endoscopic examinations of the small intestine. In recent years, the preoperative diagnosis for small intestinal malignancy has been dramatically improved due to the advance in endoscopic technologies such as double-balloon enteroscopy (DBE).1,2 Here, we describe a 53-year-old woman with a stage I jejunal adenocarcinoma diagnosed by DBE with a review of the relevant English literature with specific reference to their diagnostic modalities.

CASE REPORT

A 53-year-old woman presented to our hospital with a 13-month history of recurrent vomiting, which aggravated in frequency 10 days ago. Other complaints included anorexia, epigastric pain, and weight loss of 3 kg over 3 months. Findings of upper endoscopy performed at a primary clinic 5 days ago were normal. Her diet, medication, and past medical history were unremarkable. She appeared well, and physical examinations showed no abnormalities. Laboratory findings revealed a white cell count of 8,900/mm3, hemoglobin of 14.1 g/dL, and hematocrit of 40.6%. Findings of routine blood chemistry, serum carcinoembryonic antigen and serum carbohydrate antigen 19-9 were within normal limits. Abdominal computed tomography (CT) revealed significant localized thickening of the jejunal wall with marked dilatation proximal to the lesion (Fig. 1), but no mass lesions or abnormal findings in other organs. The radiological impression for these CT findings was a jejunal cancer or benign stricture. As there was no clue to differentiate these two diagnoses, we decided to perform an endoscopy for the direct visualization of the lesion and a preoperative histological diagnosis, if possible. Push enteroscopy was initially performed because the lesion was observed at proximal jejunum, however, visualization of the lesion by push enteroscopy was impossible because of the acute angulation of a bowel loop. For the next step, DBE using oral route was done under the conscious sedation with an intravenous bolus injection of midazolam 2 mg and propofol 20 mg. DBE of the proximal jejunum revealed an infiltrative tumor causing concentric luminal narrowing (Fig. 2A). Extensive biopsy samples were obtained, and the tumor location was marked using a hemoclip and injecting India ink (Fig. 2B). No immediate or delayed complications occurred during DBE. Endoscopic biopsy demonstrated a moderately differentiated adenocarcinoma. Laparoscopic partial jejunectomy and removal of regional lymph nodes were performed, and a 45×25×8 mm, constricting tumor (Fig. 3) was identified at a site 20 cm distal to the ligament of Treitz. Histopathological examination revealed a stage I jejunal adenocarcinoma (T2N0M0; classified according to the American Joint Committee on Cancer staging system); without invasion through the muscularis propria, lymphovascular invasion or lymph node metastasis (Fig. 4).

Postoperatively, she was stable and discharged in satisfactory condition.

DISCUSSION

Small intestinal adenocarcinoma accounts for 0.3% of all malignancies of the gastrointestinal tract and 30% to 50% of all malignancies of the small intestine.3 Despite a thorough history, physical examination and complete diagnostic workup, the correct diagnosis of small intestinal malignancy has been established preoperatively in only 50 percent of cases, with the remainder diagnosed at exploratory laparotomy. Since clinical presentations of small intestinal adenocarcinoma are vague and non-specific, they are usually diagnosed in advanced stages. The rarity of this tumor and the difficulties with endoscopic examinations in small intestine may also attribute the delayed diagnosis. As a result, survival is generally poor, with most series reporting five-year survival rates of 20-30%.3

We reviewed reports of primary jejunal adenocarcinoma identified using a computerized search of PubMed database (articles in English between 2000 and 2009). Primary jejunal adenocarcinomas associated with Crohn's disease, celiac disease or duplication cyst were excluded in this analysis. Three cases of primary jejunal adenocarcinoma in children were also excluded. Under this definition, 20 of the cases identified by the computerized search were reviewed (Table 1).4-22 There were 10 men and 9 women with a median age of 55 years. Solitary bone metastasis and primary ovarian carcinoma was the first clinical manifestation in two of them.8,22 Seven of them were diagnosed without regional or distant metastasis, however, none of them were diagnosed in stage 1 as in our case. Approximately 45% of cases were diagnosed by exploratory laparotomy (n=9) and 45% of cases were diagnosed by endoscopy (push enteroscopy, n=6; DBE, n=2; capsule endoscopy, n=1). Recent advances in DBE may facilitate preoperative histological diagnosis of small intestinal malignancy as in our case.

In the present case, the jejunal wall thickening could be attributed to the tumor, ischemic change, or inflammation as there were no symptoms, signs, and laboratory findings suggestive of a malignancy. Although some do recommend operation for a possible jejunal cancer without preoperative histological confirmation, confirming malignancy in equivocal cases may greatly increase both the compliance of patients for an operation and confidence of the physician planning a surgical resection. DBE successfully revealed an infiltrative mass with concentric luminal narrowing and facilitated correct histological diagnosis in this case. In addition, tumor marking using India ink for the exact location during DBE was helpful for the subsequent laparoscopic resection. As only DBE allows direct, controlled visualization of small bowel tumors and its histological confirmation preoperatively, it may be considered the gold standard for the diagnosis of such tumors.

In conclusion, DBE is a safe and accurate method to make a preoperative histological diagnosis of jejunal cancer. Confirming malignancy using DBE in equivocal cases may greatly increase both the compliance of patients for an operation and confidence of the physician planning a surgical resection.

Fig 1.

Figure 1.Computed tomography of the abdomen revealing significant thickening (arrow) of the jejunal wall.
Gut and Liver 2009; 3: 311-314https://doi.org/10.5009/gnl.2009.3.4.311

Fig 2.

Figure 2.(A) Double-balloon enteroscopy revealed a circumferential infiltrative mass in the proximal jejunum. (B) Note the submucosal India ink injection that was used to mark the tumor location to facilitate subsequent laparoscopic surgery.
Gut and Liver 2009; 3: 311-314https://doi.org/10.5009/gnl.2009.3.4.311

Fig 3.

Figure 3.Macroscopic examination of the lesion revealed it to be a circumferential, infiltrative tumor measuring 45×25×8 mm.
Gut and Liver 2009; 3: 311-314https://doi.org/10.5009/gnl.2009.3.4.311

Fig 4.

Figure 4.Histological examination confirmed that the tumor was a moderately differentiated adenocarcinoma, without invasion through the muscularis propria (H&E stain, ×2). There was also no lymphovascular invasion or lymph-node metastasis.
Gut and Liver 2009; 3: 311-314https://doi.org/10.5009/gnl.2009.3.4.311

Table 1 Summary of Cases with Primary Jejunal Adenocarcinoma in the English Literature between 2000 and 2009

DBE, double ballon enteroscopy; FNA, fine needle aspiration; IPC, intraperitoneal chemotherapy; PET, positron emission tomography.

*Not mentioned.

|@|DBE, double ballon enteroscopy; FNA, fine needle aspiration; IPC, intraperitoneal chemotherapy; PET, positron emission tomography.

*Not mentioned.

References

  1. Keuchel, M, Hagenmuller, F. Small bowel endoscopy. Endoscopy, 2005;37;122-132.
    Pubmed
  2. Heine, GD, Hadithi, M, Groenen, MJ, Kuipers, EJ, Jacobs, MA, Mulder, CJ. Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy, 2006;38;42-48.
    Pubmed
  3. Ugurlu, MM, Asoglu, O, Potter, DD, Barnes, SA, Harmsen, WS, Donohue, JH. Adenocarcinomas of the jejunum and ileum: a 25-year experience. J Gastrointest Surg, 2005;9;1182-1188.
    Pubmed
  4. Andriessen, MJ, Govaert, MJ, de Waard, JW. Jejunojejunal intussusception by a known jejunal adenocarcinoma. Can J Surg, 2008;51;E83-E84.
    Pubmed
  5. Chen, CW, Wang, WM, Su, YC, Wu, JY, Hsieh, JS, Wang, JY. Oxaliplatin/5-fluorouracil/leucovorin (FOLFOX4) regimen as an adjuvant chemotherapy in the treatment of advanced jejunal adenocarcinoma: a report of 2 cases. Med Princ Pract, 2008;17;496-499.
    Pubmed
  6. Sakai, Y, Tsuyuguchi, T, Ohara, T, et al. A patient with adenocarcinoma of the jejunum successfully diagnosed by preoperative endoscopy for the small intestine. Hepatogastroenterology, 2008;55;1367-1369.
    Pubmed
  7. Tankova, L, Berberova, M, Damianov, N, Tsankov, T, Kovatchki, D. Preoperative diagnosis of jejunal adenocarcinoma: a case report. J BUON, 2008;13;123-126.
    Pubmed
  8. Yamada, K, Ikehara, Y, Nakanishi, H, Kozawa, E, Tatematsu, M, Sugiura, H. Solitary bone metastasis as the first clinical manifestation in a patient with small bowel adenocarcinoma. J Orthop Sci, 2007;12;606-610.
    Pubmed
  9. Baichi, MM, Arifuddin, RM, Mantry, PS. Metachronous small bowel adenocarcinomas detected by capsule endoscopy in a patient with hereditary nonpolyposis colorectal cancer. Dig Dis Sci, 2007;52;1134-1136.
    Pubmed
  10. Moirangthem, GS, Arunkumar, C, Lokendra, K, Ramesh, L, Marak, A. Jejunal carcinoma. Trop Gastroenterol, 2005;26;199-200.
    Pubmed
  11. Yen, HH, Chen, YY, Soon, MS. Primary linitis plastica of the jejunum. Gastrointest Endosc, 2006;63;503.
    Pubmed
  12. Innis, M, Sandiford, N, Shenoy, RK, Prussia, PR, Zbar, A. Carcinoma of the jejunum with multideposit peritoneal seeding, resection and intraperitoneal chemotherapy. West Indian Med J, 2005;54;242-246.
    Pubmed
  13. Akahoshi, K, Endo, S, Kubokawa, M, et al. Primary jejunal cancer. Gastrointest Endosc, 2005;62;780.
    Pubmed
  14. Hong, SJ, Kwon, KW, Ko, BM, et al. Jejunal adenocarcinoma. Gastrointest Endosc, 2005;61;430-431.
    Pubmed
  15. Soeda, J, Sekka, T, Hasegawa, S, et al. A case of primary small intestinal cancer diagnosed by laparoscopy. Tokai J Exp Clin Med, 2004;29;159-162.
    Pubmed
  16. Yamaura, G, Yoshioka, T, Kubota, K, et al. FDG PET and gallium scintigraphy for diagnosis of an advanced jejunal adenocarcinoma with distant metastases. Clin Nucl Med, 2004;29;825-827.
    Pubmed
  17. Zeebregts, CJ, Prevo, RL, Klaase, JM. Jejunojejunal intussusception secondary to adenocarcinoma. Am J Surg, 2004;187;450-451.
    Pubmed
  18. Madisch, A, Schimming, W, Kinzel, F, et al. Locally advanced small-bowel adenocarcinoma missed primarily by capsule endoscopy but diagnosed by push enteroscopy. Endoscopy, 2003;35;861-864.
    Pubmed
  19. Tanimura, S, Higashino, M, Fukunaga, Y, Osugi, H. Laparoscopy-assisted resection for jejunal carcinoma. Surg Laparosc Endosc Percutan Tech, 2001;11;287-288.
    Pubmed
  20. Gurudu, S, Isenberg, G. Small bowel adenocarcinoma. Gastrointest Endosc, 2001;53;494.
    Pubmed
  21. Inderbitzin, D, Weber, M, Cathomas, G, Largiad?r, F. Primary small bowel carcinoma: case report. Swiss Surg, 2000;6;182-183.
    Pubmed
  22. Kilic, G, Abadi, M. Jejunal adenocarcinoma presenting as a primary ovarian carcinoma. Gynecol Oncol, 2000;78;255-258.
    Pubmed
Gut and Liver

Vol.16 No.5
September, 2022

pISSN 1976-2283
eISSN 2005-1212

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