Hackensack Meridian Ocean Medical Center Wall Township, NJ, United States
Sheilabi Seeburun, MD1, Priyaranjan Kata, MD2, Anish Kumar Kanukuntla, MD3, Vinod Nookala, MD4, Kiran Burla, MD, CMD5 1Hackensack Meridian Ocean Medical Center, Wall Township, NJ; 2Hackensack Meridian Ocean Medical Center, Brick, NJ; 3Hackensack Meridian Ocean Medical Center, Brick Township, NJ; 4Community Medical Center, Toms River, NJ; 5Gibson General Hospital, Washington, IN
Introduction: An intestinal obstruction occurs when one or both of the small or large intestines become partially or fully blocked, preventing food or fluid from passing through. A volvulus, hernia, or tumor growth may be the cause of the obstruction. In this case, findings of intestinal exploration showed two separate masses causing the obstruction.
Case Description/Methods: A 58-year-old female with no prior colonoscopy screening presented with abdominal distention and epigastric pain. She experienced one episode of vomiting since the day before and two weeks of on-off constipation. Abdomen is soft, nontender and distended without guarding or rigidity. Vitals and laboratory findings were unremarkable. Abdominal X-ray showed multiple air-fluid levels. Colonoscopy revealed two separate masses, one ulcerative tumor mass in the proximal ascending colon and another mass encasing the ileocecal valve. CT abdomen and pelvis with contrast revealed a heterogeneously enhancing mass lesion (55X36mm) seen at cecum/ascending colon associated the surrounding fat stranding, enlarged lymph nodes, and another mass (20× 20 mm) invading the ileocecal valve. Small bowel dilatation was noted up to 40mm with air fluid levels suggestive of small bowel obstruction. Patient was scheduled for right hemicolectomy. The pathologic findings showed well-differentiated adenocarcinoma with lymphovascular invasion and poorly differentiated neuroendocrine tumor grade III positive for neuron specific enolase, and Ki-67. In postoperative workup, there were no signs of metastasis and she was discharged with good functional capacity.
Discussion: Colorectal cancer is the third most common cancer diagnosed in both men and women in the US, besides skin cancers. The synchronous occurrence of two separate differentiated masses in a patient is rare with an incidence of 2-5% in general population. Incidence of neuroendocrine tumors is common in small bowel when compared to colon. However, these tumors can arise anywhere along the gastrointestinal tract. Additional long-term follow-up would likely be necessary to better understand the clinical behaviour like recurrence or other complications of such synchronous masses. Nevertheless, having identified two separate tumor masses will have an influence on postoperative treatment and follow-up decisions. This case reminds the importance of screening protocols of colonoscopy in early detection of colorectal cancers in high risk patients and the subsequent treatment to prevent potential complications.
Sheilabi Seeburun indicated no relevant financial relationships.
Priyaranjan Kata indicated no relevant financial relationships.
Anish Kumar Kanukuntla indicated no relevant financial relationships.
Vinod Nookala indicated no relevant financial relationships.
Kiran Burla indicated no relevant financial relationships.
Sheilabi Seeburun, MD1, Priyaranjan Kata, MD2, Anish Kumar Kanukuntla, MD3, Vinod Nookala, MD4, Kiran Burla, MD, CMD5. P2376 - Synchronous Intestinal Masses Causing Bowel Obstruction: A Case Report, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.