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Highlights • Adenocarcinoma of jejunum is a very rare malignant tumor worldwide. • Small intestine cancer is difficult to diagnose histologically before surgery, and whether it is diagnosed before surgery has an important influence on the surgical method. • Multidisciplinary treatment was conducted to diagnose small intestine cancer and determine treatment options, which is a global trend. • In this case, the preoperative balloon endoscopy was used to diagnose small intestine cancer histologically, as well as the location of the lesion, so that the operation could be performed by laparoscopy., Introduction and importance We report a rare case of a patient diagnosed with adenocarcinoma of the jejunum. Presentation of case The patient was a 58-year-old female patient who was tested for vomiting and dyspeptic symptoms at a local hospital and visited the hospital due to suspected small bowel obstruction. CT enteroscopy performed at our clinic revealed “progression of focal wall thickening in small bowel with proximal bowel dilatation”, and it was necessary to differentiate between malignant and infectious lesions. Balloon enteroscopy was planned for endoscopic observation up to the small bowel. The biopsy result was confirmed as adenocarcinoma with moderated differentiated. The patient underwent small bowel resection and anastomosis using standard laparoscopic surgery. Jejunum resection was performed by securing a safety margin of 10 cm or more, and sufficient LN dissection was also performed. The patient was discharged from the hospital without any specific complications, and as a result of pathology examination, it was confirmed as a stage 2 high risk group, and further treatment is in progress. Clinical discussion There are few reports of patients diagnosed with adenocarcinoma of the jejunum through symptoms of obstruction of the small intestine. Conclusions We report on a case of laparoscopic surgery for a rare jejunal cancer confirmed histologically before surgery.

Highlights • Laparoscopic duodenojejunostomy is a common intervention for the stricture of the distal duodenum. • Not all patients respond to this intervention, and methods to treat them must be discussed. • Opioid-induced bowel dysfunction caused fluids to accumulate in the jejunal loop in our case. • Jejunojejunostomy was a solution to treat our patient., Introduction Laparoscopic duodenojejunostomy is a common surgical treatment for SMA syndrome. Although there are successful cases of laparoscopic duodenojejunostomies on malignant conditions, cancer patients with opioid-induced bowel dysfunction could struggle in maintaining an oral diet despite surgical treatment of the mechanical obstruction. Case presentation A 66 year-old woman with a chemotherapy history of 18 months for Stage 4 jejunal cancer near the ligament of Treiz presented with vomiting and dehydration. She had a gastrojejunostomy constructed prior to the induction of chemotherapy. CT scan and endoscopic studies confirmed the stricture of this anastomosis due to tumor invasion. Laparoscopic duodenojejunostomy was performed, but tolerable food intake was not achieved, likely due to limited bowel movements caused by opioid use and tumor invasion of the celiac plexus. A side-to-side jejunojejunostomy was constructed, since accumulation of food in her jejunal loop was thought to be a significant cause of her limited food intake and vomiting. She was able to tolerate oral intake after the second intervention and was discharged home. Discussion Successful cases of laparoscopic duodenojejunostomy in malignant strictures of the duodenum have been reported. In this case, the outcome was not so well due to limited bowel movements caused by opioid use. Literature review of laparoscopic duodenojejunostomy on SMA syndrome revealed some cases to be unsuccessful in enabling oral feeding or resolving nausea, and methods to treat such cases could be discussed further. Conclusion Laparoscopic duodenojejunostomy is an option for malignant strictures of the duodenum, but a favorable outcome could not be achieved in our case. A side to side anastomosis of the jejunal loop and the efferent jejunum may help in improving the outcome.

Patients with esophageal cancer are susceptible to other primary cancers, but multiple primary cancers involving the esophagus and jejunum are rare. We herein report a case of primary jejunal cancer as a component of metachronous triple primary cancers including esophageal cancer and ascending colon cancer. A 63-year-old male patient with a history of surgery for esophageal cancer and ascending colon cancer was admitted to our hospital after experiencing 1 month of repeated vomiting and epigastric abdominal pain. Esophagogastroduodenoscopy, duodenography, and computed tomography revealed a jejunal tumor located 2 cm from the ligament of Treitz on the anal side. Partial resection of the jejunum with lymph node dissection was performed. The postoperative course was uneventful, and the patient remains well with no signs of recurrence 10 months after the operation. This is the first report of curative resection of triple primary cancers of the esophagus, jejunum, and colon. Patients with a history of esophageal cancer are susceptible to other primary cancers, and it is important to perform surveillance for the subsequent development of other cancers., 食道癌には他癌が合併し易いことが知られているが，空腸癌を合併することは稀である．我々は異時性三重複癌の一つとして，食道癌および上行結腸癌術後に発症した空腸癌の一例を経験したので報告する．症例は63 歳の男性であり，6年前に食道癌，8年前に上行結腸癌に対しての根治術を施行された．1ヶ月ほど続く繰り返す嘔吐と心窩部痛を主訴に受診され，上部消化管内視鏡，上部消化管造影およびCT 検査にて，トライツ靱帯から約2cm 肛門側の空腸に全周性腫瘍を認めた．手術はリンパ節郭清を伴う空腸部分切除術を施行し，術後経過は良好であり，術後10ヶ月経過した現在も再発は認めていない．根治的切除術が施行された食道癌，空腸癌および結腸癌の三重複癌の報告は初めてである．食道癌患者は他癌の合併が多くみられることより，異時性重複癌を念頭に置いた経過観察が重要である