Abstract
Adenocarcinoma which develops in the jejunal pouch has rarely been reported, but most of such cases tend to be a recurrence of primary cancer due to the presence of residual or disseminated cancer cells. Primary jejunal pouch cancer is extremely rare. We experienced an autopsy case of primary jejunal pouch cancer which occurred 14 years after proximal gastrectomy for gastric cancer. A female in her late 60s was admitted because of hypoglycemia with liver dysfunction. She underwent total gastrectomy for fundic cancer and had been reconstructed by jejunal pouch interposition 14 years prior to this presentation. Hypoglycemia recovered by nutritional support. Computed tomography demonstrated severe fatty liver and liver biopsy proved non-alcoholic steatohepatitis, which was supposed to have been induced by malnutrition. Screening esophagogastroduodenoscopy (EGD) revealed no tumorous lesions in the jejunal pouch at this time. However, her anorexia gradually progressed and the symptom of bowel obstruction appeared. EGD performed 5 months after the previous EGD revealed adenocarcinoma which extended from the anastomosis of the interposed jejunum. Then liver metastasis developed and jejunal pouch cancer invaded the abdominal wall and protruded with ulcer formation. Finally, the patient died of malnutrition. An autopsy revealed adenocarcinoma which had developed in the interposed jejunal pouch and protruded through the abdominal wall accompanied with lung and liver metastasis. We herein describe this rare case of primary interposed jejunal pouch cancer and discuss our findings including a review of the pertinent literature.
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References
Lech G, Korcz W, Kowalczyk E, et al. Primary small bowel adenocarcinoma: current view on clinical features, risk and prognostic factors, treatment and outcome. Scand J Gastroenterol. 2017;52:1194–202.
Gertler R, Rosenberg R, Feith M, et al. Pouch vs. no pouch following total gastrectomy: meta-analysis and systematic review. Am J Gastroenterol. 2009;104:2838–51.
Doussot A, Borraccino B, Patrick Rat P, et al. Construction of a jejunal pouch after total gastrectomy. J Surg Tech Case Rep. 2014;6:37–8.
Sawano T, Kawasaki H, Wajima N, et al. A case of cancer in the dilated jejunal pouch after total gastrectomy. Jpn J Cancer Ther. 2013;40:1723–5.
Kurokawa T, Kanai M, Kaneko Y, et al. Adenocarcinoma in the jejunal pouch after proximal gastrectomy for early stage upper gastric cancer: report of a case. Surg Today. 2012;42:605–9.
Miyoshi K, Fuchimoto S, Ohsaki T, et al. Suture line recurrence in jejunal pouch replaced after total gastrectomy for gastric cancer. Gastric Cancer. 1999;2:194–7.
Nishimura M, Honda I, Watanabe S, et al. Recurrence in jejunal pouch after proximal gastrectomy for early upper gastric cancer. Gastric Cancer. 2003;6:197–201.
Namikawa T, Kobayashi M, Okamoto K, et al. Recurrence of gastric cancer in the jejunal pouch after completion gastrectomy. Gastric Cancer. 2007;10:256–9.
Shinohara T, Kashiwagi H, Nakada K, et al. Suture line recurrence in the jejunal pouch after curative proximal gastrectomy for gastric cancer: report of two cases. Hepatogastroenterology. 2007;54:1902–4.
Yoo JH, Seo SH, An MS, et al. Recurrence of gastric cancer in the jejunal stump after radical total gastrectomy. World J Gastrointest Surg. 2014;6:74–6.
Blouhos K, Boulas KA, Tsalis K, et al. Jejunal pouch recurrence after extended surgery for gastric cancer: report of a case. J Gastrointest Cancer. 2014;45:148–50.
Jacquet P, Stuart OA, Dalton R, et al. Effect of intraperitoneal chemotherapy and fibrinolytic therapy on tumor implantation in wound sites. J Surg Oncol. 1996;62:128–34.
Curet MJ. Port site metastases. Am J Surg. 2004;187:705–12.
Thompson-Fawcett MW, Marcus V, Redston M, et al. Risk of dysplasia in long-term ileal pouches and pouches with chronic pouchitis. Gastroenterology. 2001;121:275–81.
Ikeda M, Watanabe K, Watanabe T, et al. Genome-wide gene expression profile of jejunal pouch mucosa as a gastric substitute. Hepatogastroenterology. 2012;59:1302–7.
Chen EY, Vaccaro GM. Small Bowel Adenocarcinoma. Clin Colon Rectal Surg. 2018;31:267–77.
Kouzu K, Tsujimoto H, Nishikawa M, et al. Risk factors for nonalcoholic fatty liver disease after gastrectomy for gastric cancer. Gastric Cancer. 2020;23:356–62.
Watanabe S, Hashimoto E, Ikejima K, et al. Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. J Gastroenterol. 2015;50:364–77.
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Yuki Kanayama, Hitoshi Takagi, Satoshi Takakusagi, Yozo Yokoyama, Kazuko Kizawa, Kyoko Marubashi, Takashi Kosone, Ken Sato, Satoru Kakizaki, Ichiro Sakamoto, Tatsurou Maehara, Etsuko Hisanaga, Hayato Ikota, and Toshio Uraoka declare that they have no conflict of interest.
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Kanayama, Y., Takagi, H., Takakusagi, S. et al. An autopsy case of primary jejunal pouch cancer which protruded from the abdominal wall 14 years after total gastrectomy for gastric cancer. Clin J Gastroenterol 13, 1091–1095 (2020). https://doi.org/10.1007/s12328-020-01177-6
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DOI: https://doi.org/10.1007/s12328-020-01177-6