Persistent Small Bowel Obstruction due to Small Bowel Adenocarcinoma: A Case Report

Small bowel obstruction (SBO), of both partial and complete types, is a condition predominantly caused by intra-abdominal adhesions and hernias. However, a known but very uncommon cause of SBO is malignancies, which are more complicated than those caused by adhesions and hernias, and associated with poorer prognoses; of these, small bowel adenocarcinoma is an even rarer etiology of SBO. The majority of SBO cases that are treated have resolution of symptoms and do not have recurrence/persistence of the condition; however, reports suggest that approximately one-fifth of SBO cases that are treated will result in recurrence/persistence of SBO requiring repeat admission. Here we report the case of an 89-year-old female with a past medical history of right lower extremity deep venous thrombosis, inferior vena cava filter placement, iron deficiency anemia, diverticular disease, internal hemorrhoids, sick sinus syndrome, emphysema, hypertension, dyslipidemia, and hypothyroidism, who presented with diarrhea and intermittent dark stool. Abdominal computed tomography (CT) while in the emergency department initially showed possible ischemic bowel and SBO. After an exploratory laparotomy with small bowel resection and adhesiolysis, pathological analysis of a resected specimen showed infiltrating small bowel adenocarcinoma. Persistence of symptoms necessitated subsequent abdominal imaging, which demonstrated persistent SBO, which was treated with a second exploratory laparotomy with small bowel resection and end ileostomy.