A 46-year-old woman was admitted to Sassoon General Hospital (SGH) three weeks ago after complaining of abdominal pain. Upon investigation, a CT scan suggested an ileocolic junction (ICJ) stricture with multiple 1-2 cm mesenteric lymph nodes. Due to the presence of multiple lymph nodes and mucin, a PET scan was performed, suggesting either an inflammatory process or malignancy.
After being discharged, the patient was readmitted within 8-10 days with acute small bowel obstruction. Further investigations led to a diagnostic laparoscopy, during which a biopsy of the mesenteric lymph nodes was taken. Pathology results confirmed mucinous adenocarcinoma, a rare but aggressive cancer commonly found at the ICJ.
Given the severity of the obstruction and the significantly dilated small bowel, nearly double the size of the colon, the surgical team converted the procedure to an open laparotomy. During the surgery, approximately 2 litres of fecal matter were removed from the obstruction, and a right hemicolectomy was performed to ensure complete removal of the cancerous tissue.
Dr Kirankumar Jadav, Unit Head and Associate Professor of General Surgery, SGH, said, "Post-surgery biopsy reports confirmed the complete excision of the malignant bowel section. The operation successfully relieved approximately 2 litres of fecal matter from the obstruction, and a right hemicolectomy was performed to ensure full removal of the cancerous tissue. While the disease is well-known, the presentation in this case was rare."
Dr Eknath Pawar, Dean, BJ Medical College, added, "The patient is now stable and scheduled for discharge, with follow-up chemotherapy planned as part of curative treatment."
ICJ Cancer: A Critical Concern
ICJ is a common site for both tuberculosis-related strictures and malignancies. While abdominal tuberculosis often presents with multiple mesenteric lymph nodes and strictures, ICJ cancer accounts for approximately 25% of all colorectal cancers. Mucinous adenocarcinoma, the most common type, typically affects patients with an average age of 71 years.
This case highlights the importance of timely diagnosis and surgical intervention in managing rare but serious gastrointestinal malignancies. Experts urge increased awareness and early screening for high-risk patients to improve treatment outcomes.
