Pseudogastroparesis as a Presentation of Adenocarcinoma of the Proximal Jejunum

Abstract

Establishing the presence of adenocarcinoma of the small bowel is exceedingly difficult. Survival is contingent on prompt diagnosis. We describe a patient with an atypical presentation of jejunal adenocarcinoma visualized via small bowel enteroclysis. She was referred with "gastroparesis," based on both a radionucleotide scan that revealed markedly delayed gastric emptying and a "normal" small bowel series. A markedly abnormal scintigraphic study and a negative small bowel series does not exclude disease of the small intestine and should provide the impetus to further pursue the possibility of an obstructing lesion. The enteroclysis is a relatively safe and effective study in the preoperative diagnosis of small bowel tumors.

Acute intestinal pseudo-obstruction

“…While gastric outlet obstruction will usually be sought for, and eliminated in this clinical context [20], one should also ensure that this clinical presentation is not a consequence of more distal small bowel obstruction. Thus, instances of acute "gastroparesis" have been reported in patients with small bowel obstruction caused by either adenocarcinoma [21] or leiomyosarcoma. [16] Interestingly, gastroparesis may also occur as a consequence of such tumors as leiomyosarcoma [22] and pancreatic carcinoma [23].…”