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

Primary tumors of the small bowel (SB) are rare, representing approximately 1% to 3% of all primary GI neoplasms. The overall incidence is increasing, probably owing to an improvement in diagnostic techniques. Small-bowel capsule endoscopy (SBCE) is a noninvasive and well tolerated procedure that allows direct visualization of the SB mucosa, with a detection rate for neoplasm ranging from 1.6% to 11.5% in procedures performed for any indication. The diagnostic yield of SBCE has previously been compared with that of CT, with either similar performance or favoring SBCE. In SBCE terminology, SB tumors are included in the protruding lesions. Typical endoscopic features include a well-defined lesion with distinctive color from the surrounding mucosa, and irregular mucosal pattern, bleeding stigmata, and ulceration. A delayed transit of the SBCE resulting in visualization of the lesion for several minutes is common. SBCE is helpful indiagnosing adenocarcinoma in the GI tract. By contrast, a submucosal tumor such as a GI stromal tumor could be mistaken as a nonspecific mucosal bulge on SBCE. The most common adverse event of SBCE is capsule retention. This rare adverse event can be seen in 2% of all placed capsules and is mostly managed conservatively. This risk can be mitigated with the use of a patency test using either imaging or a patency capsule. In this patient, with a nondiagnostic CT scan, retention was the key to identifying the location of the adenocarcinoma during surgery. This case highlights the importance of having SBCE in our repertoire for early diagnosis of SB conditions.