Ileal adenocarcinoma in a young pregnant woman: A rare case report

Abstract

Primary intestinal malignancies account for only 1%–3% of all malignant gastrointestinal tumors. Adenocarcinomas are uncommonly located in the ileum. Ileal adenocarcinoma (IA) is rare and difficult to diagnose because of its location. IA is common in older men and rare in young pregnant women. A 23-year-old pregnant woman was hospitalized several times for repeated vomiting and abdominal pain. Her symptoms were relieved after symptomatic treatment. She exhibited no typical manifestations of intestinal obstruction, such as abdominal distension, difficulty passing gas and defecation. Unfortunately, she was misdiagnosed with acute gastroenteritis. On the second day after delivery, the patient stopped passing gas and computed tomography (CT) revealed an intestinal obstruction. She was treated as paralytic ileus. However, in view of failed conservative management, she was decided for an exploratory laparotomy. A malignant ileal tumor 5cm from the ileocecal valve was found incidentally and was surgically excised accompanied with End-to-side anastomosis of ileal and transverse colon. The operation lasted 195 minutes. Pathological examination revealed an IA. Pregnant woman who experience symptoms of intestinal obstruction should be alert to the possibility of malignancy in the small intestine. IA is an insidious tumor in pregnant women. An “IA triad” can be defined as refractory vomiting, vague abdominal pain, and weight loss (or inadequate weight gain in pregnant women). Pregnant women with an IA triad should undergo investigation with endoscopy or, if necessary, magnetic resonance imaging (MRI).

Management of small bowel obstruction in the third trimester

“…We generated a total of 53 unique detailed cases of SBO in the third trimester of pregnancy excluding our case (figure 1). Factors from the literature review cases6–58 included maternal age, gestational age at the time of presentation, presenting symptoms, imaging modalities used, inpatient management approach, surgical route if applicable, intraoperative fetal heart rate monitoring if applicable, delivery timing, route of delivery, maternal outcomes, fetal outcomes and length of hospitalisation as outlined in the (online supplemental table 1). The data were extracted to a custom-made inclusive table outlining all the variables highlighted in table 1.…”