University of Colorado Anschutz Medical Campus Denver, CO
Hayder Alamily, MD1, Samantha Halen, DO2, Sana Rabeeah, MD3, Ban Mashadani, MD4, Mohammed Alani, MD5, Bisher Sawaf, MD6, Sandra Chehayeb, MD7, Mohamed Omar, MD7, Mohannad Bitar, MD8, Mushfiqur Siddique, MD8, Omer Najem, MD9 1University of Colorado Anschutz Medical Campus, Denver, CO; 2Arkansas College of Osteopathic Medicine, Fort Smith, AR; 3The University of Toledo, Toledo, OH; 4Baptist Health-University of Arkansas for Medical Sciences, North Little Rock, AR; 5Midwestern University, Goodyear, AZ; 6University of Toledo Medical Center, Toledo, OH; 7University of Kansas School of Medicine, Wichita, KS; 8Jamaica Hospital Medical Center, Jamaica, NY; 9Department of internal medicine, Trinity Health Oakland, Pontiac, MI Introduction: Small bowel adenocarcinoma (SBA) is a rare malignancy accounting for < 2% of gastrointestinal (GI) cancers. Its nonspecific presentation often delays diagnosis, limiting treatment options and worsening prognosis. We present a rare case of jejunal SBA in a healthy middle-aged woman with full remission following prompt surgical and chemotherapeutic management.
Case Description/
Methods: A 52-year-old female with no significant medical history presented with 2 months of nausea, vomiting, and 40-pound unintentional weight loss. Workup for H. pylori and GERD was unrevealing. She was admitted due to worsening symptoms and inability to tolerate oral intake. CT imaging revealed a high-grade small bowel obstruction in the mid-distal jejunum with severe proximal bowel dilation. Laparoscopy with segmental resection identified a 3.5 cm jejunal mass. Pathology confirmed moderately differentiated adenocarcinoma invading the serosa (T3N0M0, Stage IIA). MMR testing showed intact MLH1, PMS2, MSH2, and MSH6 expression, ruling out Lynch syndrome. She completed six cycles of mFOLFOX with no recurrence at 5-year follow-up. Discussion: SBA often presents late with vague GI symptoms, delaying diagnosis and worsening prognosis. Despite a healthy baseline and lack of risk factors, this patient’s case emphasizes that SBA should be considered in persistent unexplained GI complaints. Negative MMR ruled out hereditary cancer, though her presentation raised concern for Lynch syndrome. Complete remission suggests that early surgical resection combined with adjuvant chemotherapy can significantly improve long-term outcomes. This case underscores the need for early imaging in persistent GI symptoms, even in low-risk patients. Increased clinical suspicion and expedited workup may improve early SBA detection, optimize treatment, and potentially enhance survival rates.
Figure: Distal Jejunal mass at time of resection
Disclosures: Hayder Alamily indicated no relevant financial relationships. Samantha Halen indicated no relevant financial relationships. Sana Rabeeah indicated no relevant financial relationships. Ban Mashadani indicated no relevant financial relationships. Mohammed Alani indicated no relevant financial relationships. Bisher Sawaf indicated no relevant financial relationships. Sandra Chehayeb indicated no relevant financial relationships. Mohamed Omar indicated no relevant financial relationships. Mohannad Bitar indicated no relevant financial relationships. Mushfiqur Siddique indicated no relevant financial relationships. Omer Najem indicated no relevant financial relationships.
Hayder Alamily, MD1, Samantha Halen, DO2, Sana Rabeeah, MD3, Ban Mashadani, MD4, Mohammed Alani, MD5, Bisher Sawaf, MD6, Sandra Chehayeb, MD7, Mohamed Omar, MD7, Mohannad Bitar, MD8, Mushfiqur Siddique, MD8, Omer Najem, MD9. P6295 - Hidden in Plain Sight: Jejunal Adenocarcinoma Presenting as Nonspecific GI Symptoms in a Low-Risk Patient, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
