[Small-bowel obstruction as the expression of hereditary non-polyposis colorectal carcinoma]

A 25-year-old man underwent periodic coloscopy due to the occurrence of colon carcinoma in the family. At the age of 41, a mutation in the MSH2-gene was detected. More than a year after resection of the sigmoid for recurrent diverticulitis, he developed ileus in the small intestine; in the resected specimen of a non-viable portion of small intestine an adenocarcinoma was found. One year after a wide repeat resection, the patient is doing well. The prevalence of small-bowel tumours in patients with hereditary non-polyposis colorectal carcinoma (HNPCC) is relatively high, but low in absolute terms. There are no good options for screening patients for small-bowel tumours. HNPCC patients presenting with complaints that could be due to obstruction should undergo gastroduodenoscopy, coloscopy or, if these yield negative results, wireless capsule endoscopy to reveal obstruction. In case of iron deficiency anaemia or symptoms that cannot immediately be related to an obstruction, one should be careful with a diagnostic laparotomy. In any other case the threshold for a diagnostic laparotomy should be quite low.