RESUMO
Abstract Jejunal adenocarcinoma is a rare type of primary small bowelmalignancy. It is generally diagnosed at late stages and as a surgical finding, with abdominal pain or discomfort being the main associated symptom. Cases presenting with perforation are even rarer, especially without disseminated disease. The relationship between cancer and coronavirus disease 2019 (COVID-19) is still being studied, as well as the postsurgical evolution of COVID-19 patients and its possible causality of intestinal perforation. We present the case of a perforated jejunal adenocarcinoma in a COVID-19-positive patient, in whom the symptomatology secondary to the perforation led to an early diagnosis, treatment and adequate postsurgical evolution, despite the concomitant condition.
Resumo O adenocarcinoma jejunal é um tipo raro de malignidade primária do intestino delgado, o qual geralmente é diagnosticado em estágios tardios e como achado cirúrgico, sendo a dor ou o desconforto abdominal o principal sintoma associado. Casos que apresentam perfuração são ainda mais raros, principalmente sem doença disseminada. A relação entre câncer e a cornonavirus disease 2019 (covid-19) ainda está sendo estudada, assim como a evolução pós-cirúrgica de pacientes com covid-19 e sua possível causalidade de perfuração intestinal. Apresentamos o caso de um adenocarcinoma jejunal perfurado em um paciente positivo para covid-19, em que a sintomatologia secundária à perfuração levou a um diagnóstico precoce, tratamento e evolução pós-cirúrgica adequada, apesar da condição concomitante.
Assuntos
Humanos , Feminino , Adenocarcinoma/diagnóstico , COVID-19 , Perfuração Intestinal , Adenocarcinoma/cirurgia , Neoplasias IntestinaisRESUMO
RESUMEN Fundamento: los tumores del estroma gastrointestinal, conocidos en inglés como gastrointestinal stromal tumors, son tumores mesenquimales que aparecen en cualquier sitio del tracto gastrointestinal. Muchos de los cuales suelen ser pediculados y de difícil diagnóstico preoperatorio. Objetivo: exponer un caso de un tumor del estroma gastrointestinal de localización poco frecuente en duodeno, más raro aún su ubicación en yeyuno. Caso clínico: paciente masculino de 77 años de edad que presenta un tumor del estroma gastrointestinal de localización en yeyuno fue atendido en el Hospital Universitario Amalia Simoni, por el servicio de urgencia en el periodo 2016-2017. Conclusiones: los tumores mesenquimales son pocos frecuentes y los del estroma gastrointestinal lo son aún más, donde la localización yeyunal los menos encontrados y en su mayoría el diagnóstico se realiza durante el acto quirúrgico.
ABSTRACT Background: the gastrointestinal stromal tumors, are mesenchymal tumors that appear in any place of gastrointestinal tract. Many of them can be pediculate and difficult pre-operatory diagnosis. Objective: to explain a case of gastrointestinal stromal tumor of difficult localization in duodenum but it is even stranger to find it in jejune. Clinical case: a 77-year-old male patient who presents a gastrointestinal stromal tumor located in jejune, he was attended in Amalia Simoni University Hospital, by the emergency services, in the period of 2016-2017. Conclusions: the mesenchymal tumors are not frequent and those of gastrointestinal stroma are even rarer but, being the localization jejunal less found and in its majority the diagnosis is made during the surgical act.
RESUMO
Los tumores de intestino delgado son infrecuentes, generalmente se presentan con cuadros clínicos inespecíficos y la mayoría de los diagnósticos se hacen en etapas avanzadas de la enfermedad. Se presenta un paciente de sexo masculino de 58 años de edad, con dolor abdominal generalizado, intermitente, vómitos ocasionales, pérdida de peso y llenura posprandial, de dos meses de evolución. Ingresó con manifestaciones clínicas de obstrucción intestinal, y en una tomografía abdómino-pélvica se observó disminución abrupta del calibre en el yeyuno proximal. Se le practicó una laparotomía en la que se evidenció una lesión obstructiva del yeyuno que se resecó y se anastomosó el segmento. En la histopatología se reportó adenocarcinoma de yeyuno moderadamente diferenciado T3N0M0. Presentó una evolución favorable
Small bowel tumors are infrequent. Adenocarcinoma of the jejunum constitutes a rare diagnosis. It usually presents with nonspecific clinical symptoms and most patients are diagnosed in advanced stages of the disease. We present the case of a 58-year-old man with a diagnosis of jejunal adenocarcinoma, intermittent generalized abdominal pain, occasional vomiting, weight loss and postprandial fullness of two months of evolution. The patient was admitted with intestinal obstruction, with an abdominopelvic tomography showing abrupt caliber reduction at the level of the proximal jejunum. A laparotomy was performed, where an obstructive lesion was evidenced in the jejunum; resection was performed primary anastomosis. Histopathology reported moderately differentiated adenocarcinoma T3N0M0. The patient has had a favorable evolution
Assuntos
Humanos , Adenocarcinoma , Dor Abdominal , Obstrução Intestinal , Neoplasias do JejunoRESUMO
El adenocarcinoma de intestino delgado es un tumor infrecuente en la práctica clínica. Se presenta el caso de un hombre de 50 años que ingresó en el hospital en varias ocasiones por anemia refractaria al tratamiento. En el último ingreso se detectó una tumoración en región umbilical con nódulos de hermana María y José. Se realizó laparotomía exploratoria, se detectó un tumor de intestino delgado como causa de la anemia por sangrado digestivo. El diagnóstico anatomopatológico fue de un adenocarcinoma de yeyuno de bajo grado.
The adenocarcinoma of small intestine is an infrequent tumor in the clinical practice. A case of a 50 years old man is presented, admitted in the hospital in several occasions by refractory anemia to the treatment. In his last admission an umbilical region tumour with sister Mary's and Joseph's nodules was detected. Exploratory laparotomy was carried out, an small intestine tumor was detected as cause of the anemia by digestive bleeding. The anatomicopathological diagnostic was a low-grade jejunal adenocarcinoma.
RESUMO
Se presenta un caso de linfoma linfocítico bien diferenciado, en un paciente de cuarenta años que comenzó clínicamente con dolor abdominal difuso y diarreas, acompañándose de fiebre elevada y gran pérdida de peso, igualmente se constató al examen físico tumoración abdominal. Se señala la importancia de las exploraciones complementarias en esta entidad, asi como el tratamiento indicado en estos procesos.
A case of well differentiated lymphocytic lymphoma in a forty year old man is presented, which began clinically with diffused abdominal pain and diarrhea, together with high fever and great loss of weight. Also the physical examination showed an abdominal tumor. The importance of complementary exploration in this disease is pointed out, as well as the treatment indicated in this case.