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위마비로 오인된 공장선암

Adenocarcinoma of the Proximal Jejunum Misdiagnosed as Gastroparesis

김형근 ( Kim Hyung-Keun ) - 가톨릭대학교 의과대학 성바오로병원 내과학교실

조민재 ( Cho Min-Jae ) - 가톨릭대학교 의과대학 성바오로병원 내과학교실
하소영 ( Ha So-Young ) - 가톨릭대학교 의과대학 성바오로병원 내과학교실
서민지 ( Seo Min-Ji ) - 가톨릭대학교 의과대학 성바오로병원 내과학교실
문상곤 ( Moon Sang-Gon ) - 가톨릭대학교 의과대학 성바오로병원 내과학교실
오정환 ( Oh Jung-Hwan ) - 가톨릭대학교 의과대학 성바오로병원 내과학교실

Abstract


The prevalence of small bowel cancer is relatively low. The abdominal pain that patients with small bowel cancer present as a symptom is non-specific and often interpreted as a normal finding on radiographic studies. To prevent delayed diagnosis of small bowel cancer, practitioners must maintain a certain level of suspicion. We report a case of delayed diagnosis of jejunal cancer as it was misdiagnosed as gastroparesis. A 69-year-old woman complained of recurrent nausea and vomiting. At the beginning of her hospitalization, we could not diagnose mechanical obstruction through esophagogastroduodenoscopy and abdominal computed tomography. A gastric emptying study revealed delayed gastric emptying. Although the patients received treatments, including administration of prokinetics and botulinum toxin injection, for gastroparesis, her symptoms aggravated. Subsequently, plain radiography of the abdomen revealed a double-bubble sign. Abdominal computed tomography was performed under the suspicion of small bowel obstruction; however, the diagnosis was not clear. Consequently, exploratory laparoscopy was performed. She underwent surgical management, including small bowel segmental resection and duodenojejunostomy, due to the jejunal mass with involvement of the stomach, pancreatic head, and mesentery of the transverse colon. The postoperative pathological results revealed a moderately differentiated adenocarcinoma of the jejunum.

키워드

Gastric emptying; Gastroparesis; Jejunal neoplasms; Nausea
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