A case of jejunal adenocarcinoma missed at cross-sectional techniques and diagnosed by capsule endoscopy

A 50-year-old woman with Lynch syndrome presented to the emergency department with a 1-week history of abdominal pain and vomiting. The patient had undergone recent gastroscopy and colonoscopy, with no pathologic findings. During physical examination she described mesogastric abdominal pain, and laboratory evaluation showed anemia (hemoglobin 8 g/dL). A plain abdominal x-ray revealed mild small-bowel distension and a few air-fluid levels. The patient was admitted for further evaluation. Abdominal CT with contrast medium and CT enterography were performed; neither examination detected pathologic findings except for a single enlarged jejunal mesenteric lymph node (11 × 12 × 12 mm) with moderate contrast enhancement (A). Capsule endoscopy subsequently revealed a stenosing, ulcerated, spontaneously bleeding lesion in the proximal jejunum, with capsule retention (B). Laparotomic jejunal resection with laterolateral antiperistaltic anastomosis was then performed. Histologic examination revealed grade 2 intestinal adenocarcinoma (pT3NxMx) (C). Timely diagnosis proved critical for the patient’s outcome and further evidenced the importance of capsule endoscopy in the evaluation of small-bowel lesions.