Small Bowel Obstruction Caused by Metastasis

Jeanne S Chow, MD
John M Braver, MD

March 5, 1997

Presentation

Imaging Findings

Images obtained from a single-contrast small bowel follow-through demonstrate mildly dilated small bowel loops and two focal points of stenosis in the ileum (arrows).

Differential Diagnosis

• Metastasis from colonic primary tumor
• Primary cancer of the small intestine
• Metastasis from another primary tumor

Diagnosis

Discussion

At the time of the original resection and staging of adenocarcinoma, three years prior to this presentation, the lesion extended through the colonic serosa without regional lymph node involvement or metastasis, classifying it as Dukes' B₂ adenocarcinoma (AJCC T3N0Mx). Most recurrences occur within the first four years after surgical resection. Although colon cancer most commonly metastasizes to the regional lymph nodes and then to the liver, other sites including lungs, supraclavicular nodes, bone, brain or small intestine may be affected.

Another possibility is a second primary tumor arising from the small intestine. Although malignant tumors of the small intestine are rare (comprising only 3-6% of all gastrointestinal neoplasms), the risk of primary adenocarcinoma of the small bowel is increased following colorectal cancer (6). Adenocarcinomas grow circumferentially with luminal narrowing. The resulting “apple-core” or “napkin-ring" appearance is similar to the appearance of the lesions in this patient.

Other primary tumors of the small intestine such as lymphoma, carcinoid tumors and leiomyosarcomas are less likely. Other tumors which metastasize to the small intestine include melanoma, lung, breast, kidney, pancreas and stomach. In women, ovarian carcinoma is notorious for seeding any surface of the peritoneal cavity, including the small intestine.

Given the patient’s history and the morphology of the lesions, metastatic seeding from colon adenocarcinoma is the most likely diagnosis.

References

2. Eisenberg RL. Gastrointestinal radiology: a pattern approach. 2nd ed. Philadelphia: Lippincott, 1990.

3. Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL. Harrison’s principles of internal medicine. 13th ed. New York: McGraw Hill, 1994

4. Jones B, Braver JM. Essentials of gastrointestinal radiology. Philadelphia: Saunders, 1982.

5. Meyers MA, McSweeney J. Secondary neoplasms of the bowel. Radiology 1972; 105: 1-11.

6. Neugut AI, Santos J. The association between cancers of the small and large bowel. Cancer Epidemiology, Biomarkers and Prevention 1993; (2): 551-553.

7. Smith SJ, Carlson HC, Grisvold JJ. Secondary neoplasms of the small bowel. 1977;125: 29-33

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