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The CT scan (fig 1) revealed a thickened terminal ileum. The endoscopic biopsy revealed inflammation only. She received right hemicolectomy and partial ileum resection for persistent ileal obstruction. During the operation, segmental stiffness of the terminal ileum was noted (fig 2). Pathological examination (fig 3) showed metastatic lobular carcinoma, which is compatible with the previous histological finding of breast cancer. The cancer cells involved submucosa and muscularis propria but sparing the mucosa, which explained the inconclusive finding by endoscopic biopsy.
Figure 1 Abdominal CT revealed a diffuse dilated small bowel with a transitional zone at the terminal ileum; the terminal ileum wall was very enhanced and thickened (arrow).
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Figure 2 Operation specimens reveal segmental stiffness with a nodular surface of the terminal ileum (arrows).
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Figure 3 Pathology revealed (A) uniform-sized discohesive cells with round cell morphology and concentric vesicular nuclei, which had characteristics of | |||||||||
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Gut 2009 58: 741.[Extract] [Full Text] [PDF]
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