MANAGEMENT OF ILEOCECAL VALVE ADENOCARCINOMA PRESENTING AS INTESTINAL OBSTRUCTION: REPORT OF A CASE AND LITERATURE REVIEW

Introduction: Ileocecal valve adenocarcinoma is a rare cause of colorectal cancer arising at the transitional zone where ileal and colonic mucosa merge. Diagnosis of this cancer type is difficult since the patients are usually asymptomatic until complications occur.

Purpose: The aim of this study is to describe a rare case of ileocecal valve adenocarcinoma who presented with signs of partial bowel obstruction and the management plan.

Materials and methods: A 55-year-old female presented with lower abdominal pain and change in bowel habits. The patient was hemodynamically stable without any signs of peritonitis. An abdominal X-ray demonstrated dilated small bowel loops without air-fluid levels. Due to clinical suspicion, an abdominal contrast-enhanced CT scan was performed which demonstrated a 3.8 cm mass at the ileocecal valve (ICV) and hepatic lesions. The patient was admitted for further investigation. A clear-fluid diet along with nutritional supplements were initiated 48 hours after admission without causing any intolerance. Colonoscopy and magnetic resonance imaging were also carried out.

Results: Laparoscopy was finally performed in order to identify the location of the lesion and remove the cause of bowel obstruction. During laparoscopy, a solid mass was identified at the ICV, therefore a laparoscopic right hemicolectomy was performed. The post-operative recovery was uneventful. The patient returned to a regular diet on the third day and was discharged on the fourth postoperative day for further oncology follow-up.

Conclusion: The diagnosis and management of ICV tumor is challenging, commonly due to the delayed presentation and asymptomatic nature. Patients usually present with signs and symptoms of bowel obstruction and proper investigation is needed to identify the cause. Laparoscopic surgery can also be an option if the patient is hemodynamically stable and there are no signs of peritonitis rather than emergency laparotomy, as it is associated with fewer post-operative complications.