Intussuscepted Metachronous small bowel tumor after treatment for colorectal adenocarcinoma

Small Bowel adenocarcinoma (SBA) is a rare malignant neoplasm without specific signs or symptoms. It's been associated with late stage disease presentations. Midterm outcomes have suggested that after successful removal of colorectal carcinoma, there is higher risk for developing a further primary (metachronous) colorectal tumor. However when it comes to small bowel, metachronous carcinomas are unusual.

A 46-year-old female who underwent an emergency Hartmann's procedure two years previously and treatment of adjuvant chemotherapy for adenocarcinoma of the sigmoid colon at stage IIB with loco-regional recurrence. The patient presented with bowel obstruction secondary to a small bowel intussusception, confirmed by computed tomography. An emergent exploratory laparotomy was performed and confirmed of an ileal tumor as the cause of small bowel intussusception and clinical bowel obstruction. Histopathology confirmed a primary small bowel mucinous adenocarcinoma with node metastasis (T3N1M0, stage IIIB).

Patients who develop a small or large bowel adenocarcinoma have high risk of presenting a second tumor at both sites. Since data available to guide therapeutic decisions for patients presenting with small bowel metachronic tumors are scarce, the role of adjuvant therapy in patients who undergo curative resection remains unclear. The aim of this manuscript is present a case report of a patient admitted for a rare obstructive small bowel intussusception therefore underwent surgery for metachronic small bowel carcinoma from colorectal primary witch previously treated by surgery and adjuvant chemiotherapy. Studies about strategies for detection at an earlier stage, optimal treatment and prognosis are mandatory for this disease.