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Malignancies of the small bowel are a rare occurrence with a worldwide incidence of less than 1.0 per 100,000 populations. Only 2% of the total annual incidence of digestive cancers occurs in the small intestine as compared to approximately 57% in the large intestine. This is in spite of the fact that the small intestine constitutes about 75% of the entire length and 90% of the absorptive surface area of the gastrointestinal tract while the large bowel measures only about 1.5 meters in length.
We report an 84-year old Nigerian man with ileal adenocarcinoma who presented initially with nonspecific symptoms. We faced a diagnostic dilemma because of the vagueness of his symptoms and the fact that all the initial endoscopic and radiologic investigations performed were negative despite a severely elevated plasma carcinoembryonic antigen and the finding of an umbilical metastatic nodule. The diagnosis was made after 7 weeks of the initial presentation when the patient had exploratory laparotomy because of newly developed features of complete intestinal obstruction.
This report highlights the need for physicians to heighten their index of suspicion for small bowel malignancies whenever a patient presents with features suggestive of gastrointestinal malignancy but conventional endoscopic or imaging modalities yielded negative results.