Second jejunal loop adenocarcinoma associated with celiac disease. The first case report

Introduction. Jejunal adenocarcinoma is a very rare disease but the frequency of this rare carcinoma is higher in celiac patients. We report the first case report of a second jejunal loop adenocarci- noma associated with celiac disease. Presentation of case. A 47-year-old woman, with a history of celiac disease. Computerized tomographic scans of the abdomen and pelvis demonstrated a severe retroperitoneal lymphoadenopathy, pa- ra-aortic, inter-aorto-caval, porto-caval, posterior pancreaticoduo- denal space, celiac trunk, lesser gastric curvature, lymph node grou- ping. The patient underwent digiunal resection and regional lymphadenectomy. Diagnosis was poorly differentiated jejunal ade- nocarcinoma, infiltrating subserosal adipose tissue, metastasing in five out of eight regional lymph nodes. U.I.C.C. 2017 grading = pT3,pN2,G3,R0 ; Stage III B . Discussion. The jejunum accounts for 11-25% of small bowel adenocarcinoma, that accounts for less than 5% of gastrointestinal cancer, notwithstanding that 90% of the mucosa surface area of the digestive tract is made by small intestine. To the best of our know- ledge, this is the first report on a second loop jejunal adenocarcino- ma complicating celiac disease. In our study, the diagnosis of cancer was made by computed to- mography (CT) of abdomen and the patient was operated. For the diagnosis of small bowel tumour, CT enteroclysis has a sensitivity of 85-95% and a specificity of 90-96%. Complete resection (RO) of the jejunal adenocarcinoma, with regional lymph nodes resection and jejuno-jejunal anastomosis should be performed. Conclusion. After curative surgical resections of small bowel adenocarcinoma, adjuvant chemo-therapy has not shown a clear be- nefit in retrospective studies. Preoperative Chemo-Radio-therapy and careful Imaging Staging are the first steps to planning surgery.