Small Bowel Adenocarcinoma Complicating Crohn's Disease: Case Series and Review of the Literature

Author： Dossett Lesly A. White Lisa M. Welch Dereck C. Herline Alan J. Muldoon Roberta L. Schwartz David A. WiseM.D. Paul E.

Publisher： Southeastern Surgical Congress

ISSN： 0003-1348

Source： The American Surgeon, Vol.73, Iss.11, 2007-11, pp. : 1181-1187

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Abstract

Colonic adenocarcinoma frequently complicates inflammatory bowel disease of the colon, but small bowel adenocarcinoma (SBA) is a rare complication of Crohn's disease (CD). We present two patients with SBA in CD and review the literature with regards to CD-related SBA. A 45-year-old male with a 17-year history of ileal CD presented with obstructive symptoms but no radiographic evidence of a mass. After laparoscopic ileocolectomy and repair of incidental ileosigmoid fistula, pathology showed a T₃N₀ adenocarcinoma within the ileal CD. Two years after his resection he was without evidence of disease. A 59-year-old male with a 15-year history of CD presented with an acute exacerbation. Small bowel follow through demonstrated a long ileal stricture for which he underwent an ileocolic resection. Postoperative pathology confirmed a T₃N₁ CD-related SBA. He died from metastatic cancer 3 months later. Review of the literature identified 154 cases of SBA complicating CD with several distinguishing features from de novo SBA. Patients with SBA and CD are, as a group, younger and more likely to be male. SBA is rarely diagnosed preoperatively in these patients, and has a poor prognosis due to its advanced stage at diagnosis.