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Preoperative diagnostic difficulties ileocecal valve adenocarcinoma – A case report

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ABSTRACT

Introduction. Ileocecal valve adenocarcinoma is a very rare cause of bowel obstruction, very difficult to diagnose prior to surgical intervention for emergency indication. Most of the patients are symptomatic only when complications occur.

Case report. We present an exceptionally rare case of adenocarcinoma involving only the ileocecal valve, which was diagnosed intraoperatively during emergency surgery for acute bowel obstruction. The patient presented with acute bowel obstruction symptoms. Plain abdominal X-ray revealed multiple hydroaeric images suggestive for small bowel obstruction. Worsening of the symptoms leads to the decision to perform emergency surgery for acute bowel obstruction. Intraoperative palpation of cecum revealed a small tumor of the ileocecal junction, with no expression to serosa, and determining a complete stenosis at this level.

Discussion. The structures of the ileocecum may be involved in many pathological processes, many of them being common in clinical practice. The disease may involve only one of the structures, several of them simultaneously or may be part of a general process. In this case, there was no expression on the serosa, no mesenteric retraction or macroscopic adenopathy to signalize the place of the tumor. Only the abrupt transition from dilated small bowel loops to empty right colon, along with palpatory detection of the tumor revealed the diagnosis.

Conclusion. Ileocecal valve tumor evolution leads to acute bowel obstruction due to small caliber of the valve. Diagnosis is often delayed due to lack of specific symptoms and effective screening methods, and the onset is often due to complication (obstruction). Neoplasms of ileocecal valve are very rare, in the medical literature being reported only a small number of cases.

Keywords: ileocecal valve, colonic neoplasia, right hemicolectomy.

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Cristian Balalau, Nicolae Bacalbasa, Ion Motofei, Petrisor Banu, Razvan Valentin Scaunasu, Stefan Voiculescu, Denisa Balalau and Vlad Denis Constantin

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