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Management of a small bowel occlusion in a patient with stage IV adenocarcinoma and previous palliative surgery
Posted in Debates on 15 September 2015

A 53 year old male with a previous history of HIV (+) was diagnosed with a stage IV adenocarcinoma (diffuse peritoneal carcinomatosis) located at the proximal jejunum, close to the angle of Treitz. The tumor was occlusive and the patient underwent a laparoscopic gastro-jejunal anastomosis that was effective. He left the hospital and was receiving FOLFOX 4. Three months later he was readmitted due to abdominal pain, vomiting and distention. A CT Scan revealed two points of mechanical occlusions due to two carcinomatose implants, one located at the gastro jejunal anastomosis (FIG. 1) and the second due to the primary tumor (FIG. 2). Which would be your treatment of choice?

Red arrow=primary tumor, Yellow arrow=Closed loop oclussion
FIG 1. Red arrow=primary tumor, Yellow arrow=Closed loop oclussion
Large dilatation of the jejunum and duodenum
FIG 2. Large dilatation of the jejunum and duodenum

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