Surgical Resection of Metastatic Malignant Small Bowel Obstruction

Small bowel cancer is a rare cause of small bowel obstruction (SBO) that is often discovered too late, leading to a poor prognosis at diagnosis. This case describes an African American patient with a previous history of abdominal surgery who presented to the emergency department with a partial small bowel obstruction (PSBO) that failed to resolve with conservative measures, therefore requiring surgical intervention. An exploratory laparoscopy revealed a firm apple core mass obstructing the lumen of the proximal jejunum 20 cm from the ligament of Treitz. The involved portion of the small bowel was resected with wide margins and sent to pathology. The small bowel was reconstructed by a functional end-to-end anastomosis, and the patient was admitted for observation until the return of bowel function. The pathology report, returned four weeks after the patient's discharge, reported metastatic adenocarcinoma originating from the small intestine. The patient was referred to oncology for further management of his metastatic cancer. Small bowel cancer, although rare, should always be part of the differential diagnosis in the case of small bowel obstruction. If cancer is suspected during exploratory surgery, the entire peritoneal cavity should be explored, and oncologic bowel resection should be performed with adequate margins. Final staging then occurs in the postoperative period.