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Case 76: Vomiting, abdominal pain, anaemia and weight loss

You have been referred this patient from the gastroenterology team at your hospital. This woman was 61 years old and had suffered vomiting, crampy abdominal pains, and noticed weight loss over the past 3 months.

1. What investigation have the gastro team performed for you?

A small bowel Barium Meal and follow through.

2. What are the findings?

There are grossly dilated proximal small bowel loops. There is an irregular cut-off in the left upper quadrant which appears to be a shouldering mass obstructing the lumen. There are also Filshe clips on both fallopian tubes.

2. What is the differential diagnosis?

A small bowel tumour. Primary or secondary - eg melanoma, lymphoma or adenocarcinoma. Crohns stricture.

2. You suspect that this may be the uncommon diagnosis of a small bowel cancer. Where at laparotomy would you look and feel to assess for metastatic spread?

All peritoneal surfaces, the local mesenteric nodes. The liver, the rest of the small and large bowel, and importantly the ovaries for evidence of transcoelomic spread.

See the rest of Mr Grossberg's slide Collection